Individual provider Active NPI

Kazim Mohammed, PA

  • Physician Assistant
  • Fort Myers, FL
National Provider Identifier
1467911040
Registry record updated Jun 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA911644 Issued in FL
Practice address
2830 Winkler Ave Ste 207
Fort Myers, FL 33916-9301
Phone
(239) 215-4600
NPI assigned
Mar 13, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA911644 FL Primary

Addresses

Primary practice location

2830 Winkler Ave Ste 207
Fort Myers, FL 33916-9301

Mailing address

6360 Techster Blvd Ste 1
Fort Myers, FL 33966-4805
Phone (239) 223-2751

Other identifiers 1

IdentifierTypeStateIssuer
102417100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190716000481 FL Practitioner - Physician Assistant 1456686377 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4310 Metro Pkwy
Suite 205
Fort Myers, FL 33916-9416
Phone (239) 223-2751

Merit-based Incentive Payment System (MIPS)

Final score
87.43 of 100Reported as group
Quality
74.02
Promoting interoperability
100
Improvement activities
40
Cost
77.26

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA911644FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bonita Springs Retirement Village, Inc. CurrentSince Apr 1, 2019 Accepting new patients
Dna Comprehensive Therapy Services, LLC Past Accepting new patients

Locations

4310 Metro Pkwy
Ste 205
Fort Myers, FL 33916

2830 Winkler Ave
Ste 207
Fort Myers, FL 33916
Phone (239) 215-4600

3191 Harbor Blvd
Ste A
Pt Charlotte, FL 33952
Phone (941) 766-9555

Interoperability endpoints

  • Direct secure messaging: kazim.mohammed.1@13142.direct.athenahealth.com

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": "1552435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559692800000",
    "number": "1467911040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6360 TECHSTER BLVD STE 1",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339664805",
            "telephone_number": "239-223-2751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2830 WINKLER AVE STE 207",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339169301",
            "telephone_number": "239-215-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAMMED",
        "first_name": "KAZIM",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-13",
        "last_updated": "2019-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA911644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102417100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.