Individual provider Active NPI

Mohammad Fahad Faisal, DO

  • Internal Medicine Physician
  • Memphis, TN
National Provider Identifier
1336702604
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4786 Issued in TN
Practice address
3960 New Covington Pike
Memphis, TN 38128-2504
Phone
(901) 516-5741
Fax
(901) 516-5986
NPI assigned
Apr 22, 2019
Last updated
Jan 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 10798 GA
Hospitalist Physician 208M00000X 4786 TN
Internal Medicine Physician 207R00000X 4786 TN Primary

Addresses

Primary practice location

3960 New Covington Pike
Memphis, TN 38128-2504

Mailing address

1211 Union Ave Ste 330
Memphis, TN 38104-6655

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20220811003312 TN Practitioner - HospitalistPractitioner - Internal Medicine 8123353828 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Methodist Inpatient Physicians LLCGroup PAC ID 1254241235, 123 clinicians

Practice addresses (Care Compare)

1265 Union Ave
Memphis, TN 38104-3415
Phone (901) 516-2362

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4786TNMDGeneral Practice Dentistry
10798GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Inpatient Physicians LLC Internal Medicine CurrentSince Aug 29, 2022 Accepting new patients
Methodist Healthcare - Memphis Hospitals Past Accepting new patients
August University - Medical College of Georgia Internal Medicine PastSince Jul 2, 2023 Accepting new patients

Locations

1211 Union Ave
Ste 330
Memphis, TN 38104
Phone (901) 478-0954

1265 Union Ave
Memphis, TN 38104
Phone (901) 516-2362

1300 Wesley Dr
Memphis, TN 38116
Phone (901) 516-3700

3960 New Covington Pike
Memphis, TN 38128
Phone (901) 516-5200

Interoperability endpoints

  • Direct secure messaging: mfaisal30370@mlh.direct-ci.com

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

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": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1336702604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 UNION AVE STE 330",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3960 NEW COVINGTON PIKE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381282504",
            "telephone_number": "901-516-5741",
            "fax_number": "901-516-5986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAISAL",
        "first_name": "MOHAMMAD",
        "middle_name": "FAHAD",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-22",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "10798",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TN",
            "license": "4786",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "4786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.