NPIMap

Individual provider Active NPI

Masood Ahmad, M.D.

  • Psychiatry Physician
  • Jackson, MI
National Provider Identifier
1366481905
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
28864 Issued in OK
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 205-4730
Fax
(517) 205-4701
NPI assigned
Jun 6, 2006
Last updated
Aug 13, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 4301073723 MI
Psychiatry Physician 2084P0800X 35692 TN
Psychiatry Physician 2084P0800X 28864 OK Primary
General Practice Physician 208D00000X 0000035692 TN

Addresses

Primary practice location

205 N East Ave
Jackson, MI 49201-1753

Mailing address

6565 S Yale Ave
Suite 209
Tulsa, OK 74136-8327
Phone (918) 392-5400

Other practice location 1

6565 S Yale Ave
Suite 209
Tulsa, OK 74136-8327
Phone (918) 392-5400

Other identifiers 3

IdentifierTypeStateIssuer
3816082MedicaidTN
1366481905MedicaidMI
200435250AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20091208000340 MI Practitioner - Psychiatry 4981600160 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Recovery Technology LLCGroup PAC ID 3779660493, 3 clinicians

Practice addresses (Care Compare)

1200 N W Ave
Suite 400
Jackson, MI 49202-2180
Phone (517) 780-3381

205 N E Ave
Henry Ford Allegiance Health
Jackson, MI 49201-1753
Phone (517) 205-4800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301073723MIMDPsychiatry Physician
28864OKMDPsychiatry Physician
0000035692TNMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bay-Arenac Behavioral Health CurrentSince Oct 4, 2014 Accepting new patients
Tuscola County Community Mental Health Services Board CurrentSince Jul 21, 2014 Accepting new patients
W.a. Foote Memorial Hospital CurrentSince Oct 20, 2018 Accepting new patients
W.a. Foote Memorial Hospital Current Accepting new patients
Henry Ford Pathology Current Accepting new patients
W.a. Foote Memorial Hospital Psychiatry CurrentSince Oct 20, 2018 Accepting new patients
Omh Home Health Past Accepting new patients

Locations

201 Mulholland St
Bay City, MI 48708
Phone (989) 895-2222

1332 Prospect Ave
Caro, MI 48723
Phone (989) 673-6191

323 N State St
Caro, MI 48723
Phone (989) 673-6191

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

205 S East Ave
Jackson, MI 49201
Phone (517) 205-2103

Interoperability endpoints

  • Direct secure messaging: mahmad519614@direct.hfhs.org

Organizations & group practices 8

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 1

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1366481905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6565 S YALE AVE",
            "address_2": "SUITE 209",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741368327",
            "telephone_number": "918-392-5400",
            "fax_number": "918-392-5399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-205-4730",
            "fax_number": "517-205-4701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6565 S Yale Ave",
            "address_2": "Suite 209",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741368327",
            "country_code": "US",
            "telephone_number": "918-392-5400",
            "fax_number": "918-392-5399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AHMAD",
        "first_name": "MASOOD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301073723",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "35692",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OK",
            "license": "28864",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TN",
            "license": "0000035692",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3816082",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366481905",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200435250A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.