Farrukh Mahfuz Jalisi, MD

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

D84429 Issued in MD

Practice address

7845 Oakwood Rd Ste 106
Glen Burnie, MD 21061-4256

Phone

(410) 760-5100

Fax

(410) 760-5932

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 11

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WV, MD, VA3 enrollments

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 3

Specialty

Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Princeton Community Hospital Assn. Inc.Group PAC ID 3678482221, 174 clinicians

Danville Physician Practices LLCGroup PAC ID 4688606304, 171 clinicians

University of Maryland St Joseph Medical Group LLCGroup PAC ID 4880846179, 288 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sovah Health Danville Hospital, Danville, VA, CCN 490075
• University of MD St Joseph Medical Center Hospital, Towson, MD, CCN 210063
• Princeton Community Hospital Assn Inc Hospital, Princeton, WV, CCN 510046

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19847/brand/3/csg/21/fhir/r4

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.

• University of Maryland St. Joseph Medical Group, LLC

  • General Practice Physician
  • Towson, MD
  • NPI 1770836785
  Medicare reassignment Care Compare group NPD
• Danville Physician Practices LLC

  • Anesthesiology Physician
  • Danville, VA
  • NPI 1629022868

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Princeton Community Hospital Assn Inc.

  • Urology Physician
  • Princeton, WV
  • NPI 1093917643
  Medicare reassignment Care Compare group NPD
• University of Maryland Baltimore Washington Heart Associates LLC

  • Cardiovascular Disease Physician
  • Glen Burnie, MD
  • NPI 1972084507
  Medicare reassignment NPD
• University of Maryland Community Medical Group, Inc.

  • Family Medicine Physician
  • Baltimore, MD
  • NPI 1477530624
  Medicare reassignment NPD
• Upmc Western Maryland Corporation

  • Internal Medicine Physician
  • Cumberland, MD
  • NPI 1184769952
  Medicare reassignment NPD
• Upmc Western Maryland Health Services, LLC

  • Internal Medicine Physician
  • Cumberland, MD
  • NPI 1447976584
  Medicare reassignment NPD
• University Healthcare Physicians, Inc.

  • Family Medicine Physician
  • Martinsburg, WV
  • NPI 1659625739

  Internal Medicine

  Medicare reassignment NPD
• University of Maryland Community Medical Group, Inc.

  • Psychiatry Physician
  • La Plata, MD
  • NPI 1679393854
  NPD
• University of Maryland St. Joseph Medical Group, LLC

  • Surgical Assistant
  • Towson, MD
  • NPI 1053816074
  NPD
• Upmc Western Maryland Corporation

  • Mental Illness Community Based Residential Treatment Facility
  • Cumberland, MD
  • NPI 1174141592
  NPD
• Upmc Western Maryland Corporation

  • Urgent Care Clinic/Center
  • Frostburg, MD
  • NPI 1952495079
  NPD

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

• University of Maryland St. Joseph Medical Center, LLC

  • General Acute Care Hospital
  • Towson, MD
  • NPI 1124374079
  Care Compare affiliation
• Danville Regional Medical Center LLC

  • General Acute Care Hospital
  • Martinsville, VA
  • NPI 1386720183
  Care Compare affiliation
• Danville Regional Medical Center, LLC

  • Rural Acute Care Hospital
  • Danville, VA
  • NPI 1154419737
  Care Compare affiliation
• Princeton Community Hospital Assn., Inc.

  • General Acute Care Hospital
  • Princeton, WV
  • NPI 1558313213
  Care Compare affiliation

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1174621346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7845 OAKWOOD RD STE 106",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614256",
            "telephone_number": "410-760-5100",
            "fax_number": "410-760-5932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7845 OAKWOOD RD STE 106",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614256",
            "telephone_number": "410-760-5100",
            "fax_number": "410-760-5932"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12502 Willowbrook Rd",
            "address_purpose": "LOCATION",
            "city": "Cumberland",
            "state": "MD",
            "postal_code": "215026491",
            "country_code": "US",
            "telephone_number": "240-964-8740",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7601 Osler Dr",
            "address_purpose": "LOCATION",
            "city": "Towson",
            "state": "MD",
            "postal_code": "212047700",
            "country_code": "US",
            "telephone_number": "410-427-2580",
            "fax_number": "410-427-2581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JALISI",
        "first_name": "FARRUKH",
        "middle_name": "MAHFUZ",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "20266",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "241683",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WV",
            "license": "20266",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MD",
            "license": "D84429",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VA",
            "license": "0101247118",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01065461",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WV",
            "license": "20266",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "VA",
            "license": "0101247118",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IN",
            "license": "01065461",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NY",
            "license": "241683",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MD",
            "license": "D84429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810018590",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3091112",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00858196",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jasmine Ashley Jackson, RN
• Judy Carlene Jackson, RN
• Lashawnda Jackson, LMSW
• William George Jackson, MD
• Jacques P. Exposito, D.D.S. P.a.
• James C Murphy III MD PA
• Dayona Tranae James
• Monica James
• Sukhan Jamshaid
• Christine Ann Janson, R.N.

• Interventional Cardiology Physician in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Interventional Cardiology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; 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.