Individual provider Active NPI

Atm Gouse Mohiuddin, MD

  • General Practice Physician
  • Jamaica, NY
National Provider Identifier
1467061143
Registry record updated Aug 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
85700 Issued in GA
Practice address
8900 170TH St
Jamaica, NY 11432-5341
Phone
(347) 249-0768
Fax
(509) 357-0622
NPI assigned
Jul 28, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 0101280452 VA
General Practice Physician 208D00000X 85700 GA Primary

Addresses

Primary practice location

8900 170TH St
Jamaica, NY 11432-5341

Mailing address

8900 170TH St
Jamaica, NY 11432-5341
Phone (347) 249-0768

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, GA2 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
I20240829002693 VA Practitioner - General Practice 8123567542 Reassigns benefits to 1 organization
I20250124001659 GA Practitioner - General Practice 8123567542 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
85700GAMDGeneral Practice Physician
0101280452VAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health, LLC General Practice CurrentSince Jun 15, 2024 Accepting new patients
Signify Health Medical Associates, PLLC General Practice CurrentSince Oct 27, 2024 Accepting new patients

Locations

289 S Culver St
Lawrenceville, GA 30046
Phone (404) 891-9833

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

4055 Valley View Ln
Ste 700
Dallas, TX 75244
Phone (469) 466-7424

1806 Summit Ave
Richmond, VA 23230
Phone (213) 433-2823

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FCCHBD/Endpoint/FCCHBD

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755993600000",
    "number": "1467061143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8900 170TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114325341",
            "telephone_number": "347-249-0768",
            "fax_number": "509-357-0622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8900 170TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114325341",
            "telephone_number": "347-249-0768",
            "fax_number": "509-357-0622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHIUDDIN",
        "first_name": "ATM",
        "middle_name": "GOUSE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-28",
        "last_updated": "2025-08-24",
        "certification_date": "2025-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101280452",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "85700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.