Mohamad Khaled Al-Ahdab, M.D.
Individual provider Active NPI Pediatric Cardiology Physician · Wichita, KS
NPI 1336172014 · NPPES record last updated Apr 9, 2021
Key facts
- NPI
- 1336172014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Cardiology Physician 2080P0202X
- License
- 04-32074 (KS)
- Practice address
- 7015 E. Central
Suite 2
Wichita, KS 67206-1946 - Phone
- (316) 440-8800
- Fax
- (316) 440-8802
- NPI assigned
- Jul 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061101000362 | KS | Practitioner - Cardiovascular Disease (Cardiology) |
9436108461 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-32074 | KS | MD | Pediatric Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Axiom Clinic SC | Pediatric Cardiology | Past | Accepting new patients |
| Ascension Via Christi Hospitals Wichita Inc. | Past | Accepting new patients |
Interoperability endpoints
- mohamad.al-ahdab.1@9132.direct.athenahealth.com
- mohamad.al.ahdab.1@10051.direct.athenahealth.com
- mohamad.al-ahdab.1@26931.direct.athenahealth.com
- https://api.platform.athenahealth.com/9132/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | 036105004 | IL | |
| Pediatric Cardiology Physician | 2080P0202X | 04-32074 | KS | Yes |
Addresses
Primary practice location
7015 E. Central
Suite 2
Wichita, KS 67206-1946
Mailing address
7015 E Central Ave
Suite 2
Wichita, KS 67206-1943
Phone (316) 440-8800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| KS1949 | Other | KS | PTAN |
| 200096860B | Medicaid | OK | |
| 200414260C | Medicaid | KS |
Other names
- Mo Ahdab
Other providers in Wichita, KS
- Layth Al Attar
- Ahmad Al Masry
- Fadi Jamil Odeh Al Muhaisen
- Maisam Al Patty
- Nader Al Souky
- Daly Al-Hadeethi
- Ammar Al-Obaidi
- Ghiyath Al-Tabbal
- Peace Ojimaojo Alabi
- Tasneem Saleh Alaqzam
All providers in Wichita, KS · Pediatric Cardiology Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.