Ahmed Muthanna Al-Tabaqchali, MD
Individual provider Active NPI Internal Medicine Physician · Orange Park, FL
NPI 1689298945 · NPPES record last updated Aug 16, 2024
Key facts
- NPI
- 1689298945
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- ME169270 (FL)
- Practice address
- 2001 Kingsley Ave
Orange Park, FL 32073-5148 - Phone
- (904) 639-8500
- NPI assigned
- Jun 2, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 8
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Port Emergency Medical Services PC
Apogee Medical Group, Florida Inc
Practice addresses (Care Compare)
327 Beach 19TH St
Far Rockaway, NY 11691-4423
Phone (718) 869-7000
951 N Washington Ave
Titusville, FL 32796-2194
Phone (321) 268-6111
Hospital & facility affiliations
- Parrish Medical Center
- St John'S Episcopal Hospital at South Shore
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250102002417 | FL | Practitioner - Internal Medicine | 2769919703 | Reassigns benefits to 2 organizations |
| I20251216000413 | NY | Practitioner - Internal Medicine | 2769919703 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME169270 | FL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inpatient Consultants of Florida, Inc | Internal Medicine | Current |
Accepting new patients |
| Inpatient Consultants of Florida, Inc | Single Specialty | Current | Accepting new patients |
| Apogee Medical Group, Florida Inc | Single Specialty | Current |
Accepting new patients |
| Inpatient Consultants of Florida Inc | Internal Medicine | Current |
Accepting new patients |
| Narendra R Kumar M.D, PC | Single Specialty | Current |
Accepting new patients |
| Port Emergency Medical Services, P.C. | Single Specialty | Current |
Accepting new patients |
| Episcopal Health Services Inc | Past | Accepting new patients | |
| Sound a Sleep PLC | Single Specialty | Past |
Accepting new patients |
Locations
2001 W 68th St
Miami Lakes, FL 33016
Phone (305) 364-2151
350 7th St N
Naples, FL 34102
Phone (239) 436-5000
2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015
3030 W Bearss Ave
Tampa, FL 33618
Phone (813) 932-2222
951 N Washington Ave
Titusville, FL 32796
Phone (302) 325-5511
4701 Towne Centre Rd
Ste 201
Saginaw, MI 48604
Phone (517) 792-4872
200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | ME169270 | FL | Yes |
Addresses
Primary practice location
2001 Kingsley Ave
Orange Park, FL 32073-5148
Mailing address
2220 E Hammond Lake Dr
Bloomfield TWP, MI 48302
Phone (212) 423-6271
Other providers in Orange Park, FL
- Muhammad I Akhtar
- Sadia Akram
- Maria Al Chammas
- Rami Al Saidi
- Youssef Al-Saghir
- Sadie Alavi
- Rick Albarran
- Albert L Henry, MD
- Alishia Albritton
- Runelon Alcudia
All providers in Orange Park, FL · Internal Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.