Active NPI
Fatemeh Mirzamohammadi, MD,PHD
- Plastic Surgery Physician
- Kettering, OH
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 1022749
- Practice address
- 3700 Southern Blvd Ste 201
Kettering, OH 45429-1265 - Phone
- (855) 500-2873
- NPI assigned
- Apr 3, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic and Reconstructive Surgery Physician | 2086S0122X | 35.156456 | OH | |
| Plastic Surgery Physician | 208200000X | 1022749 | MA | Primary |
Addresses
Primary practice location
3700 Southern Blvd Ste 201
Kettering, OH 45429-1265
Mailing address
3700 Southern Blvd Ste 201
Kettering, OH 45429-1265
Phone (855) 500-2873
Other practice location 1
55 Fruit St
Boston, MA 02114-2696
Phone (617) 676-8785
Other practice location 2
15 Parkman St
Boston, MA 02114-3117
Phone (877) 424-5678
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CDW960678657 | Other | MA | BLUECROSS BLUESHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA, OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- General Surgery
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
55 Fruit St
Boston, MA 02114-2621
Phone (617) 726-2000
55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287
Hospital & facility affiliations
- Massachusetts General Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Massachusetts General Physicians Organization Inc | Current | Accepting new patients | |
| General Hospital Corp | Current | Accepting new patients | |
| The General Hospital Corporation | Current | Accepting new patients |
Locations
55 Fruit St
Boston, MA 02114
55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967
15 Parkman St
Boston, MA 02114
Phone (617) 726-3023
62 13th St
Charlestown, MA 02129
Phone (617) 724-4260
Interoperability endpoints
- mirzamohammadi.fatemeh.mgh@direct.partners.masshiway.net
Organizations & group practices 4
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.
-
- Dermatology Physician
- Boston, MA
- NPI 1801874573
-
- General Acute Care Hospital
- Boston, MA
- NPI 1023049236
-
- Orthopaedic Surgery Physician
- Miamisburg, OH
- NPI 1629387865
-
- General Acute Care Hospital
- Boston, MA
- NPI 1508390014
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Boston, MA
- NPI 1023049236
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781654400000",
"number": "1679079115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3700 SOUTHERN BLVD STE 201",
"city": "KETTERING",
"state": "OH",
"postal_code": "454291265",
"telephone_number": "855-500-2873",
"fax_number": "937-281-3805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 SOUTHERN BLVD STE 201",
"city": "KETTERING",
"state": "OH",
"postal_code": "454291265",
"telephone_number": "855-500-2873"
}
],
"practiceLocations": [
{
"address_1": "55 Fruit St",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "021142696",
"country_code": "US",
"telephone_number": "617-676-8785",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "15 Parkman St",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "021143117",
"country_code": "US",
"telephone_number": "877-424-5678",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MIRZAMOHAMMADI",
"first_name": "FATEMEH",
"credential": "MD,PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-03",
"last_updated": "2026-06-17",
"certification_date": "2026-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0122X",
"taxonomy_group": "",
"desc": "Surgery, Plastic and Reconstructive Surgery",
"state": "OH",
"license": "35.156456",
"primary": false
},
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "MA",
"license": "1022749",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "CDW960678657",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Kettering, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.