NPIMap

Individual provider Active NPI

Mohiedean Ghofrani, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Vancouver, WA
National Provider Identifier
1588646228
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
MD00046467 Issued in WA
Practice address
SW Washington Medical Center
Vancouver, WA 98668
Phone
(360) 514-2116
Fax
(360) 514-6517
NPI assigned
Nov 17, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 043544 CT
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD00046467 WA Primary

Addresses

Primary practice location

SW Washington Medical Center
Vancouver, WA 98668

Mailing address

PO Box 873097
Vancouver, WA 98687-3097
Phone (360) 210-7924

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20061012000614 WA Practitioner - Pathology 0446271894 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PeacehealthGroup PAC ID 9739092065, 101 clinicians

Practice addresses (Care Compare)

400 NE Mother Joseph PL
Vancouver, WA 98664-3200
Phone (360) 514-1734

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth CurrentSince Apr 14, 2018 Accepting new patients
Peacehealth CurrentSince Sep 16, 2018 Accepting new patients

Locations

1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818

1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253

400 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1588646228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 873097",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986873097",
            "telephone_number": "360-210-7924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SW WASHINGTON MEDICAL CENTER",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98668",
            "telephone_number": "360-514-2116",
            "fax_number": "360-514-6517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHOFRANI",
        "first_name": "MOHIEDEAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CT",
            "license": "043544",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WA",
            "license": "MD00046467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.