NPIMap

Individual provider Active NPI

Mehdi Mosadegh, M.D.

  • Dermatopathology Physician
  • Slidell, LA
National Provider Identifier
1629095468
Registry record updated Oct 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
13020 Issued in LA
Practice address
2104 Gause Blvd W
Ste. a
Slidell, LA 70460-4130
Phone
(985) 643-4575
Fax
(985) 643-4513
NPI assigned
Jul 17, 2006
Last updated
Oct 15, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology Physician 207ND0900X 13020 LA Primary

Addresses

Primary practice location

2104 Gause Blvd W
Ste. a
Slidell, LA 70460-4130

Mailing address

2104 Gause Blvd W
Ste. a
Slidell, LA 70460-4130
Phone (985) 643-4512

Other identifiers 1

IdentifierTypeStateIssuer
1186139MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Shapiro Dimitri Medical, LLC Dermatology Past Accepting new patients
Gulf South Medical & Surgical Institute, Inc. Past Accepting new patients
Mid-Florida Dermatology Associates P.a. Dermatology PastSince Oct 25, 2011 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444867200000",
    "number": "1629095468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 GAUSE BLVD W",
            "address_2": "STE. A",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704604130",
            "telephone_number": "985-643-4512",
            "fax_number": "985-643-4513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 GAUSE BLVD W",
            "address_2": "STE. A",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704604130",
            "telephone_number": "985-643-4575",
            "fax_number": "985-643-4513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSADEGH",
        "first_name": "MEHDI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2015-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "LA",
            "license": "13020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1186139",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.