Individual provider Active NPI

Sartaj Sultana Ahmed, M.D.

  • Allergy & Immunology Physician
  • Erie, PA
National Provider Identifier
1629255443
Registry record updated Aug 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
MD434791 Issued in PA
Practice address
3546 W 12TH St
Erie, PA 16505-3654
Phone
(814) 879-0979
Fax
(814) 452-4360
NPI assigned
Jan 23, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X MD434791 PA Primary

Addresses

Primary practice location

3546 W 12TH St
Erie, PA 16505-3654

Mailing address

3546 W 12TH St
Erie, PA 16505-3654
Phone (814) 879-0979

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20111031000300 PA Practitioner - Allergy/Immunology 9032382403 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3546 W 12TH St
Erie, PA 16505-3654
Phone (814) 879-0979

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD434791PAMDAllergy & Immunology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tri State Allergy and Asthma, LLC CurrentSince Sep 21, 2015 Accepting new patients

Locations

2409 State St
Ste D
Erie, PA 16503

3546 W 12th St
Erie, PA 16505
Phone (814) 879-0979

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566000000000",
    "number": "1629255443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3546 W 12TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165053654",
            "telephone_number": "814-879-0979",
            "fax_number": "814-452-4360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3546 W 12TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165053654",
            "telephone_number": "814-879-0979",
            "fax_number": "814-452-4360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHMED",
        "first_name": "SARTAJ",
        "middle_name": "SULTANA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-23",
        "last_updated": "2019-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "PA",
            "license": "MD434791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.