NPIMap

Individual provider Active NPI

Amjad Shahir Ata Alrashdan, MBBS

  • Cardiovascular Disease Physician
  • Marion, IN
National Provider Identifier
1295289833
Registry record updated Sep 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
01086916A Issued in IN
Practice address
330 N Wabash Ave Ste 110
Marion, IN 46952-2677
Phone
(765) 664-1201
NPI assigned
Aug 11, 2016
Last updated
Sep 5, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01086916A IN
Cardiovascular Disease Physician 207RC0000X 01086916A IN Primary

Addresses

Primary practice location

330 N Wabash Ave Ste 110
Marion, IN 46952-2677

Mailing address

330 N Wabash Ave Ste 110
Marion, IN 46952-2677

Other practice location 1

Msc 10 5550
1 University of New Mexico
Albuquerque, NM 87131-0001
Phone (505) 272-4661

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amjad.alrashdan.1@7598.direct.athenahealth.com St. Vincent Medical Group, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20220809001055 IN Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 5890081756 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Vincent Medical Group IncGroup PAC ID 7012047640, 728 clinicians

Practice addresses (Care Compare)

330 N Wabash Ave
Suite 110
Marion, IN 46952-2677
Phone (765) 664-1201

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01086916AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Medical Group Inc Cardiovascular Disease Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: amjad.alrashdan.1@7598.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1470873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1295289833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N WABASH AVE STE 110",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N WABASH AVE STE 110",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522677",
            "telephone_number": "765-664-1201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Msc 10 5550",
            "address_2": "1 University of New Mexico",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871310001",
            "country_code": "US",
            "telephone_number": "505-272-4661",
            "fax_number": "505-272-4628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALRASHDAN",
        "first_name": "AMJAD",
        "middle_name": "SHAHIR ATA",
        "credential": "MBBS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-11",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01086916A",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01086916A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amjad.alrashdan.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St. Vincent Medical Group, Inc.",
            "address_1": "330 N Wabash Ave Ste 110",
            "city": "Marion",
            "state": "IN",
            "country_code": "US",
            "postal_code": "469522677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marion, IN

Sources for this page

Verify at the official NPI Registry.