Rezwan Islam, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2004010833 Issued in MO

Practice address

850 N Hospital Dr
Ste D
Fulton, MO 65251-2535

Phone

(573) 642-5338

Fax

(573) 642-9224

NPI assigned

Jun 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Jefferson City Medical Group PCGroup PAC ID 1850371089, 117 clinicians

Nextcare Missouri LLCGroup PAC ID 7517259252, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elara Caring Home health agency, Jefferson City, MO, CCN 267600
• University of Missouri Health Care Hospital, Columbia, MO, CCN 260141

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rezwan.islam@jcmg.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jefferson City Medical Group, P.C.

  • Multi-Specialty Clinic/Center
  • Jefferson City, MO
  • NPI 1336189398
  Medicare reassignment Care Compare group NPD
• Nextcare Missouri LLC

  • Urgent Care Clinic/Center
  • Columbia, MO
  • NPI 1245694082
  Medicare reassignment Care Compare group NPD
• Jefferson City Medical Group, P.C.

  • Hematology & Oncology Physician
  • Jefferson City, MO
  • NPI 1215093257
  NPD
• Jefferson City Medical Group, P.C.

  • Family Medicine Physician
  • Fulton, MO
  • NPI 1649099714
  NPD
• Jefferson City Medical Group, P.C.

  • Clinical Medical Laboratory
  • Jefferson City, MO
  • NPI 1811292105
  NPD
• Jefferson City Medical Group, P.C.

  • Family Medicine Physician
  • Linn, MO
  • NPI 1083661615
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Curators of the University of Missouri

  • General Acute Care Hospital
  • Jefferson City, MO
  • NPI 1174597892
  Care Compare affiliation
• Curators of the University of Missouri

  • General Acute Care Hospital
  • Columbia, MO
  • NPI 1699769901
  Care Compare affiliation
• Pyramid Home Health Services- Jefferson City, Inc

  • Home Health Agency
  • Jefferson City, MO
  • NPI 1255379145
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376006400000",
    "number": "1124054556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 N HOSPITAL DR",
            "address_2": "STE F",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512535",
            "telephone_number": "573-642-5338",
            "fax_number": "573-642-9224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 N HOSPITAL DR",
            "address_2": "STE D",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512535",
            "telephone_number": "573-642-5338",
            "fax_number": "573-642-9224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISLAM",
        "first_name": "REZWAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-25",
        "last_updated": "2013-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2004010833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207313107",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deirdre Leanne Huenneke, LMT
• David Robert Hunter, MD
• Kirsten Deming Hunter
• Jesse W. Hurd, RPH
• International Eyecare Center, Inc
• Gregory Keith Ivins, M.D.
• Cheryl Ann Jackson, RPH
• Kara Beth Jaegers, R.D. L.D
• James M. McCall, D.D.S., P.C.
• James W Vann Inc

• Family Medicine Physician in Fulton, MO
• Providers in Fulton, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.