Madina House Clinic Inc

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

Legal business name

MADINA HOUSE CLINIC INC

Practice address

43575 Mission Blvd # 1019
Fremont, CA 94539-5831

Phone

(510) 902-7080

NPI assigned

Oct 17, 2023

Last updated

Apr 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Amer Syed Raheemullah, MDNPI 1629484811

Title

Medical Director/President

Phone

(510) 902-7080

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amer Syed Raheemullah, MD

  • Addiction Medicine (Preventive Medicine) Physician
  • Stanford, CA
  • NPI 1629484811
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1639951338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43575 MISSION BLVD # 1019",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945395831",
            "telephone_number": "510-902-7080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43575 MISSION BLVD # 1019",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945395831",
            "telephone_number": "510-902-7080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34517 Winslow Ter",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "CA",
            "postal_code": "945553628",
            "country_code": "US",
            "telephone_number": "510-902-7080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MADINA HOUSE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-17",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "RAHEEMULLAH",
        "authorized_official_first_name": "AMER",
        "authorized_official_middle_name": "SYED",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/PRESIDENT",
        "authorized_official_telephone_number": "510-902-7080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mario Maciel
• Scott William Mack, M.D.
• Jennifer J Madani, PSYD
• Shahnaz Madhani
• Yamini Madhavan, MD
• Aleecia Madrigal
• Karla Iran Magana Hernandez
• Marie Antoinette Magana, MSN-RN, PMHNP-BC
• Olivia Rose Magana
• Christopher Mah

• Addiction Medicine (Internal Medicine) Physician in Fremont, CA
• Providers in Fremont, CA by specialty
• Addiction Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.