NPIMap

Individual provider Active NPI

Mutahher Ibraze Mohammed

  • Family Medicine Physician
  • Urbana, OH
National Provider Identifier
1376123141
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.151461 Issued in OH
Practice address
204 Patrick Ave
Urbana, OH 43078-2302
Phone
(937) 653-3445
NPI assigned
Apr 14, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 35.151461 OH Primary

Addresses

Primary practice location

204 Patrick Ave
Urbana, OH 43078-2302

Mailing address

547 Picadilly Cir
Akron, OH 44319-1380
Phone (937) 561-5949

Other practice location 1

155 5th St NE
Barberton, OH 44203-3332
Phone (330) 615-3205

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20240808004366 OH Practitioner - Family Practice 3072919760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health Physicians Springfield Primary Care LLCGroup PAC ID 7315361359, 37 clinicians

Practice addresses (Care Compare)

204 Patrick Ave
Urbana, OH 43078-2302
Phone (937) 653-3445

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.151461OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Springfield Primary Care LLC Family Medicine CurrentSince Aug 25, 2024 Accepting new patients

Locations

1701 Mercy Health Pl
Cincinnati, OH 45237
Phone (513) 952-5000

900 Scioto St
Ste 4
Urbana, OH 43078
Phone (937) 653-4666

204 Patrick Ave
Urbana, OH 43078
Phone (937) 484-6157

Interoperability endpoints

  • Direct secure messaging: mmohammed862755@direct.bsmhealth.org

Organizations & group practices 1

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.

Hospital & facility affiliations 7

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": "1618358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1376123141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "547 PICADILLY CIR",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443191380",
            "telephone_number": "937-561-5949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 PATRICK AVE",
            "city": "URBANA",
            "state": "OH",
            "postal_code": "430782302",
            "telephone_number": "937-653-3445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 5th St NE",
            "address_purpose": "LOCATION",
            "city": "Barberton",
            "state": "OH",
            "postal_code": "442033332",
            "country_code": "US",
            "telephone_number": "330-615-3205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOHAMMED",
        "first_name": "MUTAHHER",
        "middle_name": "IBRAZE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-14",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.151461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, OH

Sources for this page

Verify at the official NPI Registry.