NPIMap

Individual provider Active NPI

Ahamed Razveen Shamsedeen, MD

  • Family Medicine Physician
  • Hanover TWP, PA
National Provider Identifier
1265710693
Registry record updated Jul 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD455218 Issued in PA
Practice address
111 W End Rd
Hanover TWP, PA 18706-5448
Phone
(201) 888-7295
NPI assigned
Aug 2, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X MD455218 PA Primary

Addresses

Primary practice location

111 W End Rd
Hanover TWP, PA 18706-5448

Mailing address

111 W End Rd
Hanover TWP, PA 18706-5448
Phone (201) 888-7295

Other identifiers 1

IdentifierTypeStateIssuer
390200000XMedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ahamed.shamsedeen.1@21771.direct.athenahealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20150714000112 PA Practitioner - Family Practice 6608008255 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Commonwealth Physician Network LLCGroup PAC ID 2668696592, 63 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

4 E Main St
Nanticoke, PA 18634-1602
Phone (570) 735-7474

500 Scott St
Wilkes Barre, PA 18702-5616
Phone (570) 824-1700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.17 of 100Reported as apm
Quality
78.34
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD455218PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Physician Network LLC Family Medicine CurrentSince Nov 15, 2023 Accepting new patients

Locations

610 Wyoming Ave
#2
Kingston, PA 18704
Phone (570) 714-1032

610 Wyoming Ave
Kingston, PA 18704
Phone (570) 288-5441

4 E Main St
Nanticoke, PA 18634
Phone (570) 258-3939

500 Scott St
Wilkes Barre, PA 18702
Phone (570) 704-0300

Interoperability endpoints

  • Direct secure messaging: ahamed.shamsedeen.1@21771.direct.athenahealth.com

Organizations & group practices 1

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 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1312243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1265710693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W END RD",
            "city": "HANOVER TWP",
            "state": "PA",
            "postal_code": "187065448",
            "telephone_number": "201-888-7295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W END RD",
            "city": "HANOVER TWP",
            "state": "PA",
            "postal_code": "187065448",
            "telephone_number": "201-888-7295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMSEDEEN",
        "first_name": "AHAMED",
        "middle_name": "RAZVEEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-02",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD455218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "390200000X",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ahamed.shamsedeen.1@21771.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "111 W End Rd",
            "city": "Hanover Twp",
            "state": "PA",
            "country_code": "US",
            "postal_code": "187065448",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hanover TWP, PA

Sources for this page

Verify at the official NPI Registry.