Individual provider Active NPI

Mahmudul Haq, M.D.

  • Gastroenterology Physician
  • Orlando, FL
National Provider Identifier
1619911146
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
ME87452 Issued in FL
Practice address
1648 Derby Glen Dr
Orlando, FL 32837-8131
Phone
(407) 760-4598
NPI assigned
Jun 15, 2006
Last updated
Dec 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X ME87452 FL Primary

Addresses

Primary practice location

1648 Derby Glen Dr
Orlando, FL 32837-8131

Mailing address

1648 Derby Glen Dr
Orlando, FL 32837-8131
Phone (407) 760-4598

Other identifiers 1

IdentifierTypeStateIssuer
109396000MedicaidFL

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120521000463 FL Practitioner - GastroenterologyPractitioner - Internal Medicine 5597928010 Reassigns benefits to 1 organization
Practice locations: Oxford, FL

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1993
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

5050 County Rd
Suite 472
Oxford, FL 34484-3750
Phone (407) 760-4598

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Gi and Hepatology Services LLC Gastroenterology CurrentSince Aug 1, 2017 Accepting new patients

Locations

5050 County Road 472
Oxford, FL 34484
Phone (352) 245-6922

Interoperability endpoints

  • Direct secure messaging: mahmudul.haq@cgahsl-fl.direct.office.nextgen.com

Organizations & group practices 1

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 5

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": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1619911146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1648 DERBY GLEN DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328378131",
            "telephone_number": "407-760-4598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1648 DERBY GLEN DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328378131",
            "telephone_number": "407-760-4598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAQ",
        "first_name": "MAHMUDUL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "ME87452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109396000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.