Negar Mahmoudzadeh

Primary specialty

DentistTaxonomy code 122300000X

License

0401415680 Issued in VA

Practice address

1200 Network Centre Dr
Effingham, IL 62401-4602

Phone

(217) 540-5100

NPI assigned

Jun 12, 2017

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

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497225600000",
    "number": "1144759242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NETWORK CENTRE DR",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624014602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NETWORK CENTRE DR",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624014602",
            "telephone_number": "217-540-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHMOUDZADEH",
        "first_name": "NEGAR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-12",
        "last_updated": "2017-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401415680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claire Christine Lustig, DMD
• Lauren Lustig
• M&T Group LLC (Central Illinois Care Services)
• Rose Maccallum
• Erica A Magelitz
• Rita Waleska Maldonado, M.D.
• Kevin D Malone, MD
• Jane Grace Mercado Manalo, M.D.
• Jennifer C Maneja, MD
• Jan Coderko Marcott, RN IBCLC RL

• Dentist in Effingham, IL
• Providers in Effingham, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.