NPIMap

Individual provider Active NPI

Mohammed A Hannan, MD

  • Internal Medicine Physician
  • Fayetteville, NC
National Provider Identifier
1417906520
Registry record updated Apr 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
9900524 Issued in NC
Practice address
2149 Valleygate Dr
Fayetteville, NC 28304-3666
Phone
(910) 484-5366
Fax
(910) 223-0583
NPI assigned
May 8, 2006
Last updated
Apr 8, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 99-00524 NC
Internal Medicine Physician 207R00000X 9900524 NC Primary

Addresses

Primary practice location

2149 Valleygate Dr
Fayetteville, NC 28304-3666

Mailing address

PO Box 87507
Fayetteville, NC 28304-3666
Phone (910) 484-5366

Other identifiers 1

IdentifierTypeStateIssuer
8912114MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20060714000233 NC Practitioner - Internal Medicine 7618980608 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Valley Internal Medicine IncGroup PAC ID 1658331327, 3 clinicians

Practice addresses (Care Compare)

2149 Valleygate Dr
Suite 102
Fayetteville, NC 28304-3666
Phone (910) 484-5366

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
99-00524NCMDInternal Medicine Physician
9900524NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Internal Medicine, Inc. Internal Medicine CurrentSince Jul 1, 2006 Accepting new patients
Cumberland County Hospital System Inc Internal Medicine CurrentSince Feb 25, 2012 Accepting new patients
Cumberland County Hospital System Inc Current Accepting new patients
Cumberland County Hospital System Inc CurrentSince Feb 25, 2012 Accepting new patients
Laurinburg Radiology Associates PA PastSince Jul 1, 2006 Accepting new patients

Locations

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

2149 Valleygate Dr
Ste 102
Fayetteville, NC 28304
Phone (910) 484-5366

3427 Melrose Rd
Fayetteville, NC 28304
Phone (910) 484-5366

Organizations & group practices 5

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 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270684800000",
    "number": "1417906520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 87507",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043666",
            "telephone_number": "910-484-5366",
            "fax_number": "910-223-0583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2149 VALLEYGATE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043666",
            "telephone_number": "910-484-5366",
            "fax_number": "910-223-0583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNAN",
        "first_name": "MOHAMMED",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-08",
        "last_updated": "2010-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "99-00524",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9900524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8912114",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.