NPIMap

Organization Active NPI

Khakwani and Mohammad Medical PC

  • Family Medicine Physician
  • Peoria, AZ
National Provider Identifier
1619682374
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KHAKWANI AND MOHAMMAD MEDICAL PC
Practice address
20542 N Lake Pleasant Rd Ste 115
Peoria, AZ 85382-9749
Phone
(623) 476-5820
Fax
(623) 476-5815
NPI assigned
Jan 17, 2023
Organization subpart
Yes
Parent organization
KHAKWANI AND MOHAMMAD MEDICAL PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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

Authorized official

Name
Valerie Denise Estrada
Title
Credentialing Manager
Phone
(469) 718-2768

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

20542 N Lake Pleasant Rd Ste 115
Peoria, AZ 85382-9749

Mailing address

PO Box 660047
Dallas, TX 75266-2900
Phone (702) 820-5713

Other names 1

  • PDS Medical Group Pleasant Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230923000296 AZ Part B Supplier - Clinic/Group Practice 8527412659 Receives reassigned benefits from 18 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Buckeye, AZ; Surprise, AZ; Phoenix, AZ; Peoria, AZ; Mesa, AZ; Laveen, AZ

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2137797PDS Medical Group Lake Pleasant20542 N Lake Pleasant Rd Ste 115, Peoria, AZ 85382Certificate of waiverOct 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Khakwani and Mohammad Med5 organizations share this tax ID, including this one
Part of
Khakwani and Mohammad Med

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1673913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1619682374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660047",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752662900",
            "telephone_number": "702-820-5713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20542 N LAKE PLEASANT RD STE 115",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853829749",
            "telephone_number": "623-476-5820",
            "fax_number": "623-476-5815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHAKWANI AND MOHAMMAD MEDICAL PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KHAKWANI AND MOHAMMAD MEDICAL PC",
        "enumeration_date": "2023-01-17",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A",
        "authorized_official_last_name": "ESTRADA",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "469-718-2768"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDS Medical Group Pleasant",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.