Individual provider Active NPI

Jaudat Mahmood

  • Interventional Pain Medicine Physician
  • Kent, OH
National Provider Identifier
1295154649
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
T1144 Issued in TX
Practice address
307 W Main St
Kent, OH 44240-2400
Phone
(800) 941-6672
NPI assigned
Apr 14, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 35.136152 OH
Pain Medicine Physician 208VP0000X 35.136152 OH
Interventional Pain Medicine Physician 208VP0014X T1144 TX Primary
Interventional Pain Medicine Physician 208VP0014X 35.136152 OH

Addresses

Primary practice location

307 W Main St
Kent, OH 44240-2400

Mailing address

120 E Beauregard Ave
San Angelo, TX 76903-5919

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20210520000758 TX Practitioner - Pain Management 7416257662 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain Management
Education
Texas Tech University Health Science Center School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shannon ClinicGroup PAC ID 0840103727, 550 clinicians
The West Texas Rehabilitation CenterGroup PAC ID 2860301215, shared by 5 NPIs, 444 clinicians

Practice addresses (Care Compare)

3605 Executive Dr
San Angelo, TX 76904-6884
Phone (325) 747-1511

4601 Hartford St
Abilene, TX 79605-4603
Phone (325) 793-3411

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.63 of 100Reported as group
Quality
78.21
Promoting interoperability
96
Improvement activities
40
Cost
67.22

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.136152OHMDPain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shannon Clinic CurrentSince Jun 1, 2021 Accepting new patients
Euclid Hospital Cleveland Clinic Health System Current Accepting new patients

Locations

120 E Beauregard Ave
San Angelo, TX 76903
Phone (915) 658-1511

3605 Executive Dr
San Angelo, TX 76904
Phone (325) 949-9555

Interoperability endpoints

  • Direct secure messaging: jmahmood1350374@direct.ccf.org

Organizations & group practices 2

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 3

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": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1295154649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 E BEAUREGARD AVE",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769035919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 W MAIN ST",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442402400",
            "telephone_number": "800-941-6672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHMOOD",
        "first_name": "JAUDAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-14",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "OH",
            "license": "35.136152",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "OH",
            "license": "35.136152",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "TX",
            "license": "T1144",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "OH",
            "license": "35.136152",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, OH

Sources for this page

Verify at the official NPI Registry.