NPIMap

Individual provider Active NPI

Mobin P Ghavami, M.D.

  • Internal Medicine Physician
  • Lodi, CA
National Provider Identifier
1447239744
Registry record updated Mar 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A54317 Issued in CA
Practice address
900 S Fairmont Ave
Ste. a
Lodi, CA 95240-5119
Phone
(209) 333-2500
Fax
(209) 333-3779
NPI assigned
Jan 13, 2006
Last updated
Mar 11, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A54317 CA Primary

Addresses

Primary practice location

900 S Fairmont Ave
Ste. a
Lodi, CA 95240-5119

Mailing address

PO Box 331
Woodbridge, CA 95258-0331
Phone (209) 333-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20040816001509 CA Practitioner - Internal MedicinePractitioner - Family Practice 6608849153 Receives reassigned benefits from 1 practitioner
Practice locations: Lodi, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
Other, 1988
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

900 S Fairmont Ave
Lodi, CA 95240-5143

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
32.92 of 100Reported as individual
Quality
18.46
Improvement activities
0
Cost
68.47

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue19
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mobin Ghavami MD CurrentSince Jan 1, 1990 Accepting new patients
Lathrop Urgent Care, a Professional Medical Corporation CurrentSince Jun 2, 2009 Accepting new patients
Lodi Memorial Hospital Association Inc Past Accepting new patients
Tracy Urgent Care, Inc Internal Medicine PastSince May 17, 2020 Accepting new patients
Lodi Memorial Hospital Association Inc Past Accepting new patients
Norcal Urgent Care, Inc PastSince Jan 15, 2013 Accepting new patients
Lodi Memorial Hospital Association Inc Past Accepting new patients

Locations

15810 S Harlan Rd
Ste A
Lathrop, CA 95330
Phone (209) 464-3615

900 S Fairmont Ave
Ste A
Lodi, CA 95240
Phone (209) 333-2500

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Organizations & group practices 7

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 6

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": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394496000000",
    "number": "1447239744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 331",
            "city": "WOODBRIDGE",
            "state": "CA",
            "postal_code": "952580331",
            "telephone_number": "209-333-2500",
            "fax_number": "209-333-3779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 S FAIRMONT AVE",
            "address_2": "STE. A",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405119",
            "telephone_number": "209-333-2500",
            "fax_number": "209-333-3779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHAVAMI",
        "first_name": "MOBIN",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2014-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A54317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.