Active NPI
Mahrukh Nisar, M.D.
- Dermatology Physician
- Oxford, AL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- MD.45230
- Practice address
- 1419 Hamric Dr E Ste 101
Oxford, AL 36203-2174 - Phone
- (256) 235-3660
- NPI assigned
- May 30, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | MD.45230 | AL | Primary |
| Dermatology Physician | 207N00000X | 186828 | OR | |
| Dermatology Physician | 207N00000X | 117661 | MT |
Addresses
Primary practice location
1419 Hamric Dr E Ste 101
Oxford, AL 36203-2174
Mailing address
209 Martin Luther King Jr Way
Tacoma, WA 98405-4265
Phone (253) 596-3300
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA, AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
286 Mitylene Park Dr
Montgomery, AL 36117-3548
Phone (334) 396-1555
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 20 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117661 | MT | MD | Dermatology Physician |
| 186828 | OR | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of Washington | Current | Accepting new patients | |
| The Metrohealth System | Current | Accepting new patients | |
| Advanced Dermatology of Alabama, Inc. | Dermatology | Current | Accepting new patients |
Locations
286 Mitylene Park Dr
Montgomery, AL 36117
Phone (334) 396-1555
200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530
209 Martin Luther King Jr Way
Tacoma, WA 98405
Phone (253) 596-3300
9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800
Interoperability endpoints
- mnisar92970@direct.metrohealth.org
Organizations & group practices 3
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.
-
- Dermatology Physician
- Montgomery, AL
- NPI 1538773775
-
- Multi-Specialty Clinic/Center
- Seattle, WA
- NPI 1396810701
-
- General Acute Care Hospital
- Cleveland, OH
- NPI 1700828852
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758585600000",
"number": "1306283411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 MARTIN LUTHER KING JR WAY",
"city": "TACOMA",
"state": "WA",
"postal_code": "984054265",
"telephone_number": "253-596-3300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1419 HAMRIC DR E STE 101",
"city": "OXFORD",
"state": "AL",
"postal_code": "362032174",
"telephone_number": "256-235-3660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISAR",
"first_name": "MAHRUKH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-30",
"last_updated": "2025-09-23",
"certification_date": "2025-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "AL",
"license": "MD.45230",
"primary": true
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "OR",
"license": "186828",
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MT",
"license": "117661",
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
"affiliation": "N",
"endpointDescription": "Carequality",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "209 Martin Luther King Jr Way",
"city": "Tacoma",
"state": "WA",
"country_code": "US",
"postal_code": "984054265",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Oxford, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.