Organization Active NPI

Mohammed I Ahmed Service Corporation

  • General Practice Physician
  • Chicago, IL
National Provider Identifier
1467765891
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
036081126 Issued in IL
Legal business name
MOHAMMED I AHMED SERVICE CORPORATION
Practice address
2803 W Harrison St
Chicago, IL 60612-3332
Phone
(773) 533-5523
Fax
(773) 533-1479
NPI assigned
Jul 14, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Authorized official

Name
Dr. Mohammed Ismail Ahmed, M.D.NPI 1427035500
Title
Owner
Phone
(773) 533-5523

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X 036081126 IL Primary

Addresses

Primary practice location

2803 W Harrison St
Chicago, IL 60612-3332

Mailing address

737 S Fairfield Ave
Lombard, IL 60148-3503
Phone (773) 533-5523

Other identifiers 1

IdentifierTypeStateIssuer
036081126MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101118001279 IL Part B Supplier - Clinic/Group Practice 8022204841 Receives reassigned benefits from 1 practitioner
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

2803 W Harrison St
Chicago, IL 60612
Phone (312) 553-5523

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.

NPI Registry JSON

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

{
    "created_epoch": "1279065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1467765891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 S FAIRFIELD AVE",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601483503",
            "telephone_number": "773-533-5523",
            "fax_number": "773-533-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2803 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123332",
            "telephone_number": "773-533-5523",
            "fax_number": "773-533-1479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAMMED I AHMED SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-14",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_middle_name": "ISMAIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-533-5523",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "IL",
            "license": "036081126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036081126",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.