Ebrahim Ahmed Mohamedy, M.D.
Individual provider Active NPI Internal Medicine Physician · Temecula, CA
NPI 1528051216 · NPPES record last updated Jun 17, 2020
Key facts
- NPI
- 1528051216
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- A63714 (CA)
- Practice address
- 12784 Pechanga Rd.
Temecula, CA 92390 - Phone
- (678) 591-9108
- NPI assigned
- Aug 26, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 14
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Riverside-San Bernardino County Indian Health Inc
Practice addresses (Care Compare)
11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone (909) 864-1097
47001 Pala Rd
Temecula, CA 92592-2925
Phone (951) 676-6810
48360 Pechanga Rd
Temecula, CA 92592-2986
Phone (951) 676-6810
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130514000266 | CA | Practitioner - Internal Medicine | 1456253319 | Reassigns benefits to 1 organization |
| I20200427000210 | TX | Practitioner - Family Practice | 1456253319 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A63714 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverside-San Bernardino County Indian Health, Inc. | Current | Accepting new patients | |
| Family Health Centers of San Diego Inc | Current |
Accepting new patients | |
| Family Health Centers of San Diego Inc | Current | Accepting new patients | |
| Family Health Centers of San Diego, Inc | Current | Accepting new patients | |
| Family Health Centers of San Diego, Inc | Current |
Accepting new patients | |
| Riverside-San Bernardino County Indian Health, Inc | Current |
Accepting new patients | |
| Riverside-San Bernardino County Indian Health, Inc | Current |
Accepting new patients | |
| Family Health Centers of San Diego Inc | Current | Accepting new patients | |
| United Emergency Services, Inc. | Past | Accepting new patients | |
| Jasper Health Services, Inc. | Internal Medicine | Past | Accepting new patients |
Locations
53000 Cahuilla Rd
Anza, CA 92539
Phone (909) 864-1097
11555 Potrero Rd
#1-2
Banning, CA 92220
Phone (909) 849-4761
11980 Mount Vernon Ave
Grand Terrace, CA 92313
Phone (909) 783-8470
823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323
3544 30th St
San Diego, CA 92104
Phone (619) 515-2424
12784 Pechanga Rd
Temecula, CA 92592
Phone (678) 591-9108
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | A63714 | CA | Yes |
Addresses
Primary practice location
12784 Pechanga Rd.
Temecula, CA 92390
Mailing address
12220 Malabar Dr
Poway, CA 92064-2433
Phone (678) 591-9079
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000798344E | Medicaid | GA | |
| A63714 | Other | CA | W5352A |
Other providers in Temecula, CA
- Warren Andrew Mitchell
- Willie M Mitchell III
- Mobile Picc Professional Corporation
- Mobile Swallow Evals, Inc.
- Samantha Moedano
- Mohammad Abul Fielat DDS Inc
- Mohammad Ali Zareh DDS Inc
- Michelle Mohammadi
- Wisal Mohebi
- Waseem Mohiuddin
All providers in Temecula, CA · Internal Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.