Individual provider Active NPI

Mohammad I. Al-Raie, P.A.

  • Medical Physician Assistant
  • Albuquerque, NM
National Provider Identifier
1629345848
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA2011-0027 Issued in NM
Practice address
8200 Central Ave SE
Albuquerque, NM 87108-2408
Phone
(505) 272-5885
Fax
(505) 272-5888
NPI assigned
Nov 17, 2011
Last updated
Jun 24, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA2011-0027 NM Primary

Addresses

Primary practice location

8200 Central Ave SE
Albuquerque, NM 87108-2408

Mailing address

711 Encino PL NE Ste D
Albuquerque, NM 87102-2650
Phone (505) 224-7400

Other identifiers 1

IdentifierTypeStateIssuer
27782093MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111215000699 NM Practitioner - Physician Assistant 1456526672 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of New Mexico School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
McLeod Medical Centers of NM IncGroup PAC ID 5092075531, 54 clinicians

Practice addresses (Care Compare)

1108 US Route 66 W
Moriarty, NM 87035-1006
Phone (505) 281-5180

11501 Montgomery Blvd NE
Albuquerque, NM 87111-2796
Phone (505) 281-5180

1901 Juan Tabo Blvd NE
Albuquerque, NM 87112-3303
Phone (505) 281-5180

7200 Montgomery Blvd NE
Suite 7121
Albuquerque, NM 87109-1510
Phone (505) 281-5180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services CurrentSince Nov 1, 2013 Accepting new patients
McLeod Medical Centers of NM, Inc. CurrentSince Oct 1, 2021 Accepting new patients
Presbyterian Healthcare Services CurrentSince Nov 1, 2013 Accepting new patients
Taos Health Systems, Inc., Holy Cross Hospital Past Accepting new patients

Locations

11501 Montgomery Blvd NE
Albuquerque, NM 87111
Phone (505) 814-1333

1648 Alameda Blvd NW
Albuquerque, NM 87114
Phone (505) 585-0085

1901 Juan Tabo Blvd NE
Albuquerque, NM 87112
Phone (505) 262-9200

4410 Irving Blvd NW
Albuquerque, NM 87114
Phone (505) 768-6123

7200 Montgomery Blvd NE
Albuquerque, NM 87109
Phone (505) 814-1995

12127 N State Highway 14
Ste 5
Cedar Crest, NM 87008
Phone (505) 281-2460

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

1851 Old US 66
Edgewood, NM 87015
Phone (505) 281-8463

517 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 326-2255

1202 Main St NE
Ste A
Los Lunas, NM 87031
Phone (505) 565-0070

Interoperability endpoints

  • Direct secure messaging: mohammad.al-raie.1@27050.direct.athenahealth.com

Organizations & group practices 8

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": "1321488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1629345848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 ENCINO PL NE STE D",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022650",
            "telephone_number": "505-224-7400",
            "fax_number": "505-224-7404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 CENTRAL AVE SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871082408",
            "telephone_number": "505-272-5885",
            "fax_number": "505-272-5888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL-RAIE",
        "first_name": "MOHAMMAD",
        "middle_name": "I.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-17",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA2011-0027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "27782093",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.