Individual provider Active NPI

Mohammed Jomha, MD

  • Family Medicine Physician
  • Indianapolis, IN
National Provider Identifier
1164943585
Registry record updated Jul 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11019668A Issued in IN
Practice address
1520 N Senate Ave
Indianapolis, IN 46202-2213
Phone
(310) 735-5734
NPI assigned
Jul 6, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11019668A IN Primary

Addresses

Primary practice location

1520 N Senate Ave
Indianapolis, IN 46202-2213

Mailing address

1520 N Senate Ave
Indianapolis, IN 46202-2213
Phone (317) 962-9792

Other identifiers 1

IdentifierTypeStateIssuer
MJOMHA5734MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499299200000",
    "number": "1164943585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 N SENATE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022213",
            "telephone_number": "317-962-9792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 N SENATE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022213",
            "telephone_number": "310-735-5734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOMHA",
        "first_name": "MOHAMMED",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-06",
        "last_updated": "2017-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11019668A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MJOMHA5734",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.