Individual provider Active NPI

Mohammed J Mohiuddin, M.D.

  • Anesthesiology Physician
  • Loves Park, IL
National Provider Identifier
1417945379
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
036.142717 Issued in IL
Practice address
2202 Harlem Road
Loves Park, IL 61111-2754
Phone
(815) 877-4848
Fax
(815) 654-5342
NPI assigned
Oct 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 43730020 WI
Anesthesiology Physician 207L00000X 036.142717 IL Primary

Addresses

Primary practice location

2202 Harlem Road
Loves Park, IL 61111-2754

Mailing address

2202 Harlem Road
Loves Park, IL 61111-2754
Phone (815) 877-4848

Other identifiers 2

IdentifierTypeStateIssuer
34131900MedicaidWI
12952OtherWIDEANCARE HMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 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
I20110127001153 WI Practitioner - Anesthesiology 3971515446 Reassigns benefits to 1 organization
I20190319000969 IL Practitioner - AnesthesiologyPractitioner - Pain Management 3971515446 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Pain Management
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1401 E State St
Swedishamerican Hospital
Rockford, IL 61104-2315
Phone (815) 968-4400

Hospital & facility affiliations

  • Uw Health Hospital, Rockford, IL, CCN 140228

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.142717ILMDAnesthesiology Physician
43730020WIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Anesthesiologists Associated, L.L.C. Anesthesiology CurrentSince Apr 1, 2025 Accepting new patients
Ias Illinois PC Anesthesiology CurrentSince Feb 1, 2025 Accepting new patients
Stateline Anesthesiologists SC Anesthesiology CurrentSince Sep 10, 2001 Accepting new patients
Rockford Anesthesiologists Associated, L.L.C. Past Accepting new patients
Hart Road Pathology SC Past Accepting new patients

Locations

2525 Kaneville Rd
Geneva, IL 60134
Phone (630) 584-1400

2202 Harlem Rd
Loves Park, IL 61111
Phone (815) 877-4848

1401 E State St
Rockford, IL 61104
Phone (815) 489-4267

5605 E Rockton Rd
Roscoe, IL 61073
Phone (815) 525-4000

1969 W Hart Rd
Beloit, WI 53511
Phone (608) 364-5011

3005 S Riverside Dr
Ste 206
Beloit, WI 53511

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1417945379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 HARLEM ROAD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611112754",
            "telephone_number": "815-877-4848",
            "fax_number": "815-654-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 HARLEM ROAD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611112754",
            "telephone_number": "815-877-4848",
            "fax_number": "815-654-5342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHIUDDIN",
        "first_name": "MOHAMMED",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "43730020",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036.142717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34131900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEANCARE HMO",
            "identifier": "12952",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loves Park, IL

Sources for this page

Verify at the official NPI Registry.