NPIMap

Individual provider Active NPI

Mohammed K Qaisi, DMD, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Chicago, IL
National Provider Identifier
1679783088
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
036.139464 Issued in IL
Practice address
1969 W Ogden Ave # Clinicd
Chicago, IL 60612-3765
Phone
(128) 645-1633
NPI assigned
May 23, 2007
Last updated
Apr 28, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 019.030516 IL
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 036.139464 IL Primary

Addresses

Primary practice location

1969 W Ogden Ave # Clinicd
Chicago, IL 60612-3765

Mailing address

1969 W Ogden Ave
Chicago, IL 60612-3765
Phone (128) 645-1633

Other practice location 1

2500 N State St
University of Mississippi Medical Center
Jackson, MS 39216-4500
Phone (601) 815-1181

Other identifiers 1

IdentifierTypeStateIssuer
21459MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mqaisi@direct.ccprovider.org Direct Cook County

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140609002334 MS Practitioner - Oral Surgery 8820212038 Reassigns benefits to 1 organization
I20160314001703 IL Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 8820212038 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Oral SurgeryAlso: Maxillofacial Surgery
Education
Louisiana State University School of Medicine in New Orleans, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oral and Maxilloficial Head and Neck Associates LLCGroup PAC ID 1951634500, 5 clinicians

Practice addresses (Care Compare)

811 W Wellington Ave
Chicago, IL 60657-5123
Phone (773) 296-7645

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
019.030516ILMDOral and Maxillofacial Surgery (Dentist)
036.139464ILMDOral & Maxillofacial Surgery (D.M.D.)

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center Current Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jan 3, 2014 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jan 3, 2014 Accepting new patients
Cook County Current Accepting new patients
Cook County CurrentSince Feb 10, 2016 Accepting new patients
Oral and Maxilloficial Head and Neck Associates LLC Oral & Maxillofacial Surgery CurrentSince Jul 1, 2019 Accepting new patients
Cook County CurrentSince Feb 10, 2016 Accepting new patients

Locations

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

1969 W Ogden Ave
Chicago, IL 60612
Phone (312) 864-3600

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

811 W Wellington Ave
Chicago, IL 60657
Phone (773) 871-1461

836 W Wellington Ave
Chicago, IL 60657
Phone (773) 296-7054

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

Interoperability endpoints

  • Direct secure messaging: mqaisi@direct.ccprovider.org

Organizations & group practices 7

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1679783088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1969 W OGDEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123765",
            "telephone_number": "128-645-1633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1969 W OGDEN AVE # CLINICD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123765",
            "telephone_number": "128-645-1633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 N State St",
            "address_2": "University of Mississippi Medical Center",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164500",
            "country_code": "US",
            "telephone_number": "601-815-1181",
            "fax_number": "601-815-5306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QAISI",
        "first_name": "MOHAMMED",
        "middle_name": "K",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019.030516",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "IL",
            "license": "036.139464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21459",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mqaisi@direct.ccprovider.org",
            "affiliation": "Y",
            "affiliationName": "Cook County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1969 W. Ogden Ave.",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606123723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.