NPIMap

Individual provider Active NPI

Mahboob Ali Quaderi, M.D.

  • Internal Medicine Physician
  • Willoughby, OH
National Provider Identifier
1184724551
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35-069891 Issued in OH
Practice address
5105 Som Center Road
Willoughby, OH 44094
Phone
(216) 524-7377
Fax
(440) 975-4617
NPI assigned
Sep 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35-069891 OH Primary

Addresses

Primary practice location

5105 Som Center Road
Willoughby, OH 44094

Mailing address

1001 Lakeside Ave E
#1200
Cleveland, OH 44114-1158

Other identifiers 1

IdentifierTypeStateIssuer
0416704MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mahboobquaderi@uhps.allscripsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051007000531 OH Practitioner - Internal Medicine 3274558374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11100 Euclid Ave
Cleveland, OH 44106-1716

158 W Main Rd
Conneaut, OH 44030-2039

1611 S Green Rd
Suite 065
South Euclid, OH 44121-4129
Phone (216) 383-0100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-069891OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Primary Care Practices Inc CurrentSince Mar 1, 2016 Accepting new patients
University Primary Care Practices Inc Current Accepting new patients
University Primary Care Practices Inc Internal Medicine CurrentSince Mar 1, 2016 Accepting new patients
University Primary Care Practices Past Accepting new patients

Locations

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

1611 S Green Rd
Ste 160
South Euclid, OH 44121
Phone (216) 297-2073

Interoperability endpoints

  • Direct secure messaging: mquaderi35945@ehrdirect.uhhospitals.org

Organizations & group practices 4

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 7

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": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1184724551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 LAKESIDE AVE E",
            "address_2": "#1200",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441141158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5105 SOM CENTER ROAD",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "44094",
            "telephone_number": "216-524-7377",
            "fax_number": "440-975-4617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUADERI",
        "first_name": "MAHBOOB",
        "middle_name": "ALI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-069891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0416704",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mahboobquaderi@uhps.allscripsdirect.net",
            "affiliation": "N",
            "address_1": "1611 S Green Rd",
            "city": "South Euclid",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441214129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Willoughby, OH

Sources for this page

Verify at the official NPI Registry.