Omar Mendoza Mahmood, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY24715 Issued in CA

Practice address

10801 National Boulevard
Suite 611
Los Angeles, CA 90064-4170

Phone

(310) 273-4843

Fax

(310) 273-5056

NPI assigned

Jun 7, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Psychologist

Education

Wayne State University School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Executive Mental Health, IncGroup PAC ID 0345209102, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Executive Mental Health, Inc.

  • Mental Health Counselor
  • Los Angeles, CA
  • NPI 1275670036
  Medicare reassignment Care Compare group
• Brian Wu MD PHD Inc

  • Psychiatry Physician
  • San Gabriel, CA
  • NPI 1528639481
  NPD

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

{
    "created_epoch": "1339027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436918400000",
    "number": "1326309154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10801 NATIONAL BOULEVARD",
            "address_2": "SUITE 611",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900644170",
            "telephone_number": "310-273-4843",
            "fax_number": "310-273-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10801 NATIONAL BOULEVARD",
            "address_2": "SUITE 611",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900644170",
            "telephone_number": "310-273-4843",
            "fax_number": "310-273-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHMOOD",
        "first_name": "OMAR",
        "middle_name": "MENDOZA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-07",
        "last_updated": "2015-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY24715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "GH439Y",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Salina Mahgerefteh, D.D.S.
• Shirly Mahgerefteh, PA-C
• Gabrielle Mahler, DMD
• Michael E Mahler, MD
• Fizza Mahmood, MD
• Uzair Ahmed Mahmood, MD
• Sheba R Mahmoodian, DMD
• Mahmoud Nouh, MD; Inc.
• Homa Mahmoudi, PHD
• Kevin Keon Mahmoudi

• Clinical Neuropsychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; 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.

Verify at the official NPI Registry.