Active NPI
Mohammed I Ahmed Service Corporation
- General Practice Physician
- Chicago, IL
National Provider Identifier
1467765891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 036081126
- 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
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.
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036081126 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
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.
-
- General Practice Physician
- Chicago, IL
- NPI 1427035500
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.