NPIMap

Individual provider Active NPI

Gibran Hamid Mahmud, M.D.

  • Hematology & Oncology Physician
  • Centralia, IL
National Provider Identifier
1518132489
Registry record updated Dec 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
2011020105 Issued in MO
Practice address
1052 M L King Dr
Suite 2
Centralia, IL 62801-3002
Phone
(618) 436-5410
Fax
(618) 436-8063
NPI assigned
Apr 23, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2011020105 MO
Hematology & Oncology Physician 207RH0003X 2011020105 MO Primary

Addresses

Primary practice location

1052 M L King Dr
Suite 2
Centralia, IL 62801-3002

Mailing address

1052 M L King Dr
Suite 2
Centralia, IL 62801-3002
Phone (618) 436-5410

Other identifiers 2

IdentifierTypeStateIssuer
1518132489MedicaidMO
1518132489MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20150526002561 IL Practitioner - Hematology/Oncology 6901077593 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1052 M L King Dr
Suite 2
Centralia, IL 62801-3002
Phone (618) 436-5410

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cancer Care Specialists of Central Illinois, S.C CurrentSince Jan 1, 2017 Accepting new patients
Cancer Care Specialists of Central Illinois, S.C. Hematology & Oncology CurrentSince Jan 1, 2017 Accepting new patients
Salem Township Hospital Past Accepting new patients

Locations

1052 M L King Dr
Ste 2
Centralia, IL 62801
Phone (618) 436-5410

210 W McKinley Ave
Ste 1
Decatur, IL 62526
Phone (217) 876-6600

210 W McKinley Ave
#1
Decatur, IL 62526
Phone (217) 877-9442

213 NW 10th St
Ste D
Fairfield, IL 62837
Phone (217) 329-3232

321 Regency Park
Ste 100
O Fallon, IL 62269
Phone (618) 416-7970

1201 Ricker Rd
Salem, IL 62881
Phone (618) 548-3194

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480896000000",
    "number": "1518132489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1052 M L KING DR",
            "address_2": "SUITE 2",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013002",
            "telephone_number": "618-436-5410",
            "fax_number": "618-436-8063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1052 M L KING DR",
            "address_2": "SUITE 2",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013002",
            "telephone_number": "618-436-5410",
            "fax_number": "618-436-8063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHMUD",
        "first_name": "GIBRAN",
        "middle_name": "HAMID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-23",
        "last_updated": "2016-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2011020105",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MO",
            "license": "2011020105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1518132489",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1518132489",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centralia, IL

Sources for this page

Verify at the official NPI Registry.