Maqbool Ahmad, M.D.

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

036051996 Issued in IL

Practice address

1200 W Deyoung St
Marion, IL 62959-4437

Phone

(608) 993-5686

Fax

(618) 997-6250

NPI assigned

Aug 23, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 20

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: direct@marioneyecentermarionil.compulinkdirect.com

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.

• Marion Eye Anesthesia Group LLC

  • Anesthesiology Physician
  • Marion, IL
  • NPI 1881927762
  NPD (past) Authorized official
• Marion Eye Center Anesthesia Group Inc

  • Anesthesiology Physician
  • Marion, IL
  • NPI 1235413246
  NPD (past) Authorized official

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491782400000",
    "number": "1699768911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W DEYOUNG ST",
            "address_2": "P.O. BOX 1178",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629594437",
            "telephone_number": "608-993-5686",
            "fax_number": "618-997-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W DEYOUNG ST",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629594437",
            "telephone_number": "608-993-5686",
            "fax_number": "618-997-6250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHMAD",
        "first_name": "MAQBOOL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2017-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036-051996",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "35374",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "IL",
            "license": "036051996",
            "primary": true
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "MO",
            "license": "35374",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870010",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870013",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SHIELD OF MO",
            "identifier": "133794",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARMONY HEALTH PLAN",
            "identifier": "236683",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00418684, CI6575",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "034431",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "100033",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "791580195",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870008",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870002",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870023",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870030",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870022",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870027",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870028",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870007",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203169800",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036051996",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC NUMBER",
            "identifier": "0814870031",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kirun Naseem Ahmad, D.O.
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• Deborah O. Alcorn, LCSW
• Alexander Family Practice LLC

• All providers in Marion, IL
• Retina Specialist (Ophthalmology) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.