Mohammed A Memon, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

042588 Issued in CT

Practice address

415 Silas Deane Hwy
Suite #210
Wethersfield, CT 06109-2124

Phone

(860) 436-9880

Fax

(860) 436-9850

NPI assigned

May 11, 2006

Last updated

Aug 27, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mohammed.memon@glacecentral.com

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.

• Manchester Family Care LLC

  • Clinic/Center
  • South Windsor, CT
  • NPI 1740395755
  Medicare reassignment NPD Authorized official
• Pediatric Health Associates of Coneecticut, LLC

  • Pediatric Adolescent Medicine Physician
  • Wethersfield, CT
  • NPI 1780246306
  NPD
• East Hartford Medical Center Inc

  • Pediatrics Physician
  • East Hartford, CT
  • NPI 1942274113

  Family Medicine

  NPD (past)
• Everyday Medical Care Center LLC

  • Family Medicine Physician
  • New Britain, CT
  • NPI 1336189646
  NPD (past)
• Meriden Health Care LLC

  • Pediatrics Physician
  • Meriden, CT
  • NPI 1366497299

  Family Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409097600000",
    "number": "1609826668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 SILAS DEANE HWY",
            "address_2": "SUITE 210",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061092124",
            "telephone_number": "860-436-9880",
            "fax_number": "860-436-9850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 SILAS DEANE HWY",
            "address_2": "SUITE #210",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061092124",
            "telephone_number": "860-436-9880",
            "fax_number": "860-436-9850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEMON",
        "first_name": "MOHAMMED",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2014-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "042588",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "042588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE FAMILY PLAN",
            "identifier": "00142588500",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "4637105",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P3623891",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001425885",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "3722953",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NEW ENGLAND",
            "identifier": "36663",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "2V7183",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "010042588CT01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "042588",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meaningful Journeys With Rebecca
• Medical Management Plus
• Roberto M Medina, MD
• Sarah Mehigen, BCBA, LBA
• Tracee Joy Melendez, LCSW
• Anthea Mendez, APRN
• Michael Dibiase LLC
• Daniel Michalak, PHARM.D
• John David Milavsky, LCSW
• Carla Jean Miller

• Internal Medicine Physician in Wethersfield, CT
• Providers in Wethersfield, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.