Individual provider Active NPI

Mohammed Faizan, M.D.

  • Pediatric Nephrology Physician
  • Providence, RI
National Provider Identifier
1255338240
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
License
10821 Issued in RI
Practice address
593 Eddy St
Hasbro 122
Providence, RI 02903-4923
Phone
(401) 444-6195
Fax
(401) 444-6378
NPI assigned
Jul 5, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nephrology Physician 2080P0210X 10821 RI Primary

Addresses

Primary practice location

593 Eddy St
Hasbro 122
Providence, RI 02903-4923

Mailing address

593 Eddy St
Hasbro 122
Providence, RI 02903-4923
Phone (401) 444-6195

Other identifiers 1

IdentifierTypeStateIssuer
MF45698MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20050124000807 RI Practitioner - NephrologyPractitioner - Pediatric Medicine 6608826003 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Pediatric Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rhode Island HospitalGroup PAC ID 8921900044, 430 clinicians

Practice addresses (Care Compare)

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-4471

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10821RIMDPediatric Nephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rhode Island Hospital CurrentSince Feb 17, 2010 Accepting new patients
Lifespan Corporation Current Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Dec 1, 2019 Accepting new patients
Rhode Island Hospital CurrentSince Feb 17, 2010 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Dec 1, 2019 Accepting new patients
Children'S Hospital & Regional Medical Center 2 Past Accepting new patients
Rhode Island Hospital Past Accepting new patients

Locations

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

900 Warren Ave
Ste 201
East Providence, RI 02914
Phone (401) 444-3575

701 George Washington Hwy
Ste 104
Lincoln, RI 02865
Phone (401) 444-8311

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

593 Eddy St
Ste 5
Providence, RI 02903
Phone (401) 444-3996

593 Eddy St
Lowr
Providence, RI 02903
Phone (401) 444-4471

593 Eddy St
#942
Providence, RI 02903
Phone (401) 444-5672

101 Dudley St
Providence, RI 02905
Phone (401) 453-7950

593 Eddy St
Providence, RI 02903

593 Eddy St
#122
Providence, RI 02903
Phone (401) 444-6195

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

Interoperability endpoints

  • Direct secure messaging: mfaizan14238@brownhealth.medalliesdirect.net

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255338240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "HASBRO 122",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-6195",
            "fax_number": "401-444-6378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "HASBRO 122",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-6195",
            "fax_number": "401-444-6378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIZAN",
        "first_name": "MOHAMMED",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "RI",
            "license": "10821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MF45698",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.