Active NPI
Mahdi Shafiq
- Family Medicine Physician
- Brooksville, FL
National Provider Identifier
1548880917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME162874
- Practice address
- 14540 Cortez Blvd
Brooksville, FL 34613-6056 - Phone
- (352) 597-8287
- NPI assigned
- Apr 25, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME162874 | FL | Primary |
Addresses
Primary practice location
14540 Cortez Blvd
Brooksville, FL 34613-6056
Mailing address
169 Riverside Dr
Binghamton, NY 13905-4246
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240208000203 | FL | Order and Referring Only - Family Practice | 4981047800 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705363200000",
"number": "1548880917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "169 RIVERSIDE DR",
"city": "BINGHAMTON",
"state": "NY",
"postal_code": "139054246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14540 CORTEZ BLVD",
"city": "BROOKSVILLE",
"state": "FL",
"postal_code": "346136056",
"telephone_number": "352-597-8287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFIQ",
"first_name": "MAHDI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-25",
"last_updated": "2024-01-16",
"certification_date": "2024-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME162874",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooksville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.