Jack P Mourad,MD,Inc

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

8219 Issued in RI

Legal business name

JACK P MOURAD,MD,INC

Practice address

226 Auburn St
Cranston, RI 02910-2852

Phone

(401) 461-8450

Fax

(401) 461-8640

NPI assigned

Sep 29, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jack P Mourad, M.D.

Title

President

Phone

(401) 461-8450

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in RI

Enrollment records 1

Locations

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

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229904000000",
    "number": "1669622478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 AUBURN ST",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029102852",
            "telephone_number": "401-461-8450",
            "fax_number": "401-461-8640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 AUBURN ST",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029102852",
            "telephone_number": "401-461-8450",
            "fax_number": "401-461-8640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK P MOURAD,MD,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-29",
        "last_updated": "2008-12-22",
        "status": "A",
        "authorized_official_last_name": "MOURAD",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "401-461-8450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "RI",
            "license": "8219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9002703",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110179243",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "22724",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUESHIELD",
            "identifier": "2703-4",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "04-01308",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTH CARE",
            "identifier": "64476",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Interventional and Functional Pain Center
• Sofia Irons, LCSW
• Alexandra Maria Irving, LMFT
• Liza Marie Izzo
• Maria Jablonski, O.D.
• Gene M Jacobs, D.O.
• Michael Lee Jacobs, PT, DPT
• Sarah C Jacobs, LCSW
• Jeffrey Lee Jacobson, OD
• James K. Cardi,M.D.,Inc

• Rheumatology Physician in Cranston, RI
• Providers in Cranston, RI by specialty
• Rheumatology Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2008; 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.