Individual provider Active NPI

Mohammad A Afridi, MD

  • Psychiatry Physician
  • Waterloo, IA
National Provider Identifier
1417093071
Registry record updated Dec 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
18455 Issued in IA
Practice address
146 W Dale St Ste 101
Waterloo, IA 50703-1901
Phone
(319) 233-3351
Fax
(319) 235-3132
NPI assigned
Jan 30, 2007
Last updated
Dec 14, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 18455 IA Primary

Addresses

Primary practice location

146 W Dale St Ste 101
Waterloo, IA 50703-1901

Mailing address

146 W Dale St
Ste 101
Waterloo, IA 50703
Phone (319) 233-3351

Other identifiers 1

IdentifierTypeStateIssuer
1087486MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18455IAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Capstone Behavioral Healthcare, Inc PastSince Oct 3, 2018 Accepting new patients
Poweshiek County Mental Health Center Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323820800000",
    "number": "1417093071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 W DALE ST",
            "address_2": "STE 101",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "50703",
            "telephone_number": "319-233-3351",
            "fax_number": "319-235-3132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 W DALE ST STE 101",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507031901",
            "telephone_number": "319-233-3351",
            "fax_number": "319-235-3132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AFRIDI",
        "first_name": "MOHAMMAD",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2011-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IA",
            "license": "18455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1087486",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.