NPIMap

Individual provider Active NPI

Ahmed A Taranissi, MD

  • Psychiatry Physician
  • Mexico, MO
National Provider Identifier
1215978689
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2000165586 Issued in MO
Practice address
340 Kelley Pkwy
Mexico, MO 65265-3811
Phone
(573) 582-1234
Fax
(573) 582-1212
NPI assigned
Jun 9, 2006
Last updated
Oct 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 2000165586 MO Primary
Child & Adolescent Psychiatry Physician 2084P0804X 2000165586 MO

Addresses

Primary practice location

340 Kelley Pkwy
Mexico, MO 65265-3811

Mailing address

340 Kelley Pkwy
Mexico, MO 65265-3811
Phone (573) 582-1234

Other identifiers 1

IdentifierTypeStateIssuer
1215978689MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20050131000905 MO Practitioner - Psychiatry 9537119169 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

340 Kelley Pkwy
Mexico, MO 65265-3811
Phone (573) 582-1234

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2000165586MOMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Central Missouri Behavioral Health Services, Inc CurrentSince Jul 22, 2008 Accepting new patients
East Central Missouri Behavioral Health Services, Inc CurrentSince Jul 21, 2008 Accepting new patients
Centerpointe Hospital of Columbia, LLC CurrentSince Apr 29, 2019 Accepting new patients
Burrell, Inc. Past Accepting new patients
Curators of the University of Missouri Past Accepting new patients

Locations

1201 International Dr
Columbia, MO 65202
Phone (573) 615-2001

340 Kelley Pkwy
Mexico, MO 65265
Phone 5735821234 ext. 3017

4801 Weldon Spring Pkwy
Weldon Spring, MO 63304
Phone (636) 441-7300

Interoperability endpoints

  • Direct secure messaging: ahmed.taranissi.p1@direct.arthurcenter.nextgenshare.com

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Arthur Center Community HealthMexico, MO, CCN 261071 Federally qualified health center Corporate Director Jan 1, 2011
Arthur Center Behavioral HealthFulton, MO, CCN 261166 Federally qualified health center Corporate Officer
Operational/Managerial Control		 Jul 21, 2008
Jul 21, 2008
Arthur Center Behavioral HealthMontgomery City, MO, CCN 791143 Federally qualified health center W-2 Managing Employee Jun 1, 2021

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1215978689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 KELLEY PKWY",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652653811",
            "telephone_number": "573-582-1234",
            "fax_number": "573-582-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 KELLEY PKWY",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652653811",
            "telephone_number": "573-582-1234",
            "fax_number": "573-582-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARANISSI",
        "first_name": "AHMED",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "2000165586",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MO",
            "license": "2000165586",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215978689",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mexico, MO

Sources for this page

Verify at the official NPI Registry.