Active NPI
Azma Ahmed, DDS
- Dentist
- Portland, OR
National Provider Identifier
1417341983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D10191
- Practice address
- 12750 SE Stark St BLDG E
Portland, OR 97233-1539 - Phone
- (971) 347-3009
- Fax
- (971) 256-3277
- NPI assigned
- Mar 23, 2015
- Last updated
- Nov 17, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 33934 | TX | |
| Dentist | 122300000X | DE60540896 | WA | |
| Dentist | 122300000X | D10191 | OR | Primary |
Addresses
Primary practice location
12750 SE Stark St BLDG E
Portland, OR 97233-1539
Mailing address
1776 SW Madison St
Portland, OR 97205-1715
Phone (503) 224-1044
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2073790 | Medicaid | WA | |
| 500696873 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160715000931 | OR | Order and Referring Only - Other (Non-Physician) | 3173815883 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10191 | OR | MD | Dentist |
| 33934 | TX | MD | Dentist |
Interoperability endpoints
- aahmed324338@direct.ochin.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605571200000",
"number": "1417341983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1776 SW MADISON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972051715",
"telephone_number": "503-224-1044",
"fax_number": "503-621-2235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12750 SE STARK ST BLDG E",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972331539",
"telephone_number": "971-347-3009",
"fax_number": "971-256-3277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AHMED",
"first_name": "AZMA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-23",
"last_updated": "2020-11-17",
"certification_date": "2020-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "33934",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE60540896",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D10191",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2073790",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500696873",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.