Individual provider Active NPI

Aliasghar Mohyuddin, M.D.

  • Internal Medicine Physician
  • Ithaca, NY
National Provider Identifier
1174595136
Registry record updated Sep 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
215037-1 Issued in NY
Practice address
1780 Hanshaw Rd
Ithaca, NY 14850-9105
Phone
(607) 257-5858
Fax
(607) 257-1718
NPI assigned
Feb 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD068766L PA
Internal Medicine Physician 207R00000X 215037-1 NY Primary

Addresses

Primary practice location

1780 Hanshaw Rd
Ithaca, NY 14850-9105

Mailing address

1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858

Other identifiers 5

IdentifierTypeStateIssuer
GU039894OtherPAPA MEDICARE GROUP
110209182OtherNYRR MEDICARE PIN
01980905MedicaidNY
0017551190001MedicaidPA
CC8362OtherNYRR MEDICARE GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20170206001524 CA Practitioner - Internal MedicinePractitioner - Hospitalist 7012047368 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Hahnemann University College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

400 N McDowell Blvd
Petaluma, CA 94954-2339
Phone (707) 778-2631

Hospital & facility affiliations

  • Providence Queen of the Valley Medical Center Hospital, Napa, CA, CCN 050009

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
215037-1NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Sep 21, 2020 Accepting new patients
Providence Medical Foundation CurrentSince Sep 21, 2020 Accepting new patients
Hospitalist Medicine Physicians of California, Inc Internal Medicine CurrentSince Jan 1, 2017 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Inpatient Specialists of California, PC Internal Medicine CurrentSince Jan 1, 2017 Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

1100 Trancas St
Ste 209
Napa, CA 94558
Phone (707) 251-1850

1000 Trancas St
Napa, CA 94558
Phone (707) 226-2901

400 N McDowell Blvd
Petaluma, CA 94954
Phone (707) 778-1111

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

1000 Greenley Rd
Sonora, CA 95370
Phone (209) 263-0803

1800 N California St
Stockton, CA 95204
Phone (209) 467-6400

525 W Acacia St
Stockton, CA 95203
Phone (209) 944-5410

Interoperability endpoints

  • Direct secure messaging: amohyuddin7404@direct-guthrie.org

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316044800000",
    "number": "1174595136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 HANSHAW RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148509105",
            "telephone_number": "607-257-5858",
            "fax_number": "607-257-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHYUDDIN",
        "first_name": "ALIASGHAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2011-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD068766L",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "215037-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA MEDICARE GROUP",
            "identifier": "GU039894",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "110209182",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01980905",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017551190001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP",
            "identifier": "CC8362",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

Verify at the official NPI Registry.