Individual provider Active NPI

Mohamed G Mohamed, MD

  • Geriatric Medicine (Family Medicine) Physician
  • New Smyrna Beach, FL
National Provider Identifier
1386721579
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
252170 Issued in NY
Practice address
1914 State Road 44
New Smyrna Beach, FL 32168-8345
Phone
(386) 428-3241
Fax
(844) 295-1379
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X ME116369 FL
Geriatric Medicine (Family Medicine) Physician 207QG0300X 252170 NY Primary
Family Medicine Physician 207Q00000X MD430130 PA

Addresses

Primary practice location

1914 State Road 44
New Smyrna Beach, FL 32168-8345

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Other identifiers 2

IdentifierTypeStateIssuer
03080848MedicaidNY
ME116369OtherFLMEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mohamed.mohamed.1@29601.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090429000262 NY Practitioner - Family PracticePractitioner - Geriatric Medicine 6103974290 Reassigns benefits to 1 organization
I20131105000595 FL Practitioner - Family Practice 6103974290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conviva Medical Center Management, LLCGroup PAC ID 4284717422, 507 clinicians

Practice addresses (Care Compare)

1914 Sr
Suite 44
New Smyrna Beach, FL 32168
Phone (386) 428-3241

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD430130PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Conviva Medical Center Management LLC Family Medicine CurrentSince Aug 9, 2023 Accepting new patients
Mary Imogene Bassett Hospital CurrentSince Jul 8, 2019 Accepting new patients
Mary Imogene Bassett Hospital CurrentSince Jul 8, 2019 Accepting new patients
Metcare of Florida, Inc Past Accepting new patients

Locations

5238 Norwood Ave
#16
Jacksonville, FL 32208
Phone (904) 265-2050

4960 SW 72nd Ave
Ste 406
Miami, FL 33155

6101 Waterford District Dr
Ste 200
Miami, FL 33126
Phone (407) 533-6836

1914 State Road 44
New Smyrna Beach, FL 32168
Phone (386) 428-3241

1914 State Road 44
Ste B
New Smyrna Beach, FL 32168
Phone (386) 428-3241

1430 SW Saint Lucie West Blvd
Ste 101
Port St Lucie, FL 34986
Phone (772) 877-3591

178 Grandview Dr
Cobleskill, NY 12043
Phone (518) 254-3456

1 Atwell Rd
Cooperstown, NY 13326
Phone (607) 547-3480

321 E Albany St
Herkimer, NY 13350
Phone (315) 867-2700

Interoperability endpoints

  • Direct secure messaging: mohamed.mohamed.1@29601.direct.athenahealth.com

Organizations & group practices 4

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 4

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1386721579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1914 STATE ROAD 44",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321688345",
            "telephone_number": "386-428-3241",
            "fax_number": "844-295-1379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAMED",
        "first_name": "MOHAMED",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME116369",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "252170",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD430130",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03080848",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME116369",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mohamed.mohamed.1@29601.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "1914 State Road 44 Ste B",
            "city": "New Smyrna Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321688345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New Smyrna Beach, FL

Sources for this page

Verify at the official NPI Registry.