Active NPI
Ijaz Mahmood
- Family Nurse Practitioner
- Vancouver, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP61657288
- Practice address
- 13711 NE 100TH St
Vancouver, WA 98682-2884 - Phone
- (360) 953-0266
- NPI assigned
- Feb 11, 2025
- Last updated
- Feb 11, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP61657288 | WA | Primary |
Addresses
Primary practice location
13711 NE 100TH St
Vancouver, WA 98682-2884
Mailing address
13711 NE 100TH St
Vancouver, WA 98682-2884
Phone (360) 953-0266
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR, WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
10435 SE Cora St
Portland, OR 97266-2331
Phone (206) 823-1004
2805 NE 129TH St
Vancouver, WA 98686-3324
Phone (360) 787-4092
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP61657288 | WA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Impact Physician Group, LLC | Current | Accepting new patients | |
| Impact Physician Group, Washington LLC | Current | Accepting new patients | |
| Daiya Healthcare PLLC | Current | Accepting new patients | |
| Vibra Physicians LLC | Current | Accepting new patients |
Locations
21 Eastbrook Bnd
Ste 218
Peachtree Cty, GA 30269
Phone (260) 407-8007
10300 NE Hancock St
Portland, OR 97220
Phone (503) 257-5500
10435 SE Cora St
Portland, OR 97266
Phone (503) 760-1737
75 Shore Dr
Saint Helens, OR 97051
Phone (503) 397-2713
2805 NE 129th St
Vancouver, WA 98686
Phone (360) 356-1890
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Vancouver, WA
- NPI 1457008971
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Legacy Salmon Creek Providers
- Clinic/Center
- Vancouver, WA
- NPI 1356357784
Hospital
-
- General Acute Care Hospital
- Vancouver, WA
- NPI 1700809829
-
dba PeaceHealth SW Heart & Vascular Center
- Cardiovascular Disease Physician
- Vancouver, WA
- NPI 1003194911
Hospital
-
dba PeaceHealth Southwest Medical Center
- General Acute Care Hospital
- Vancouver, WA
- NPI 1134178999
-
dba Unity Center for Behavioral Health-PES
- General Acute Care Hospital
- Portland, OR
- NPI 1003367491
-
dba Legacy Laboratory Services
- Clinical Medical Laboratory
- Portland, OR
- NPI 1295756898
Hospital
-
- General Acute Care Hospital
- Portland, OR
- NPI 1831112358
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739232000000",
"number": "1689489049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13711 NE 100TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986822884",
"telephone_number": "360-953-0266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13711 NE 100TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986822884",
"telephone_number": "360-953-0266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHMOOD",
"first_name": "IJAZ",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-02-11",
"last_updated": "2025-02-11",
"certification_date": "2025-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WA",
"license": "AP61657288",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; 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.