NPIMap

Individual provider Active NPI

Mohammad R Rahman, M.D.

  • Internal Medicine Physician
  • Loudon, TN
National Provider Identifier
1700847985
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD13686 Issued in TN
Practice address
111 Clyde St
Loudon, TN 37774-1566
Phone
(865) 458-1554
Fax
(865) 458-1762
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD13686 TN Primary

Addresses

Primary practice location

111 Clyde St
Loudon, TN 37774-1566

Mailing address

111 Clyde St
Loudon, TN 37774-1566
Phone (865) 458-1554

Other identifiers 1

IdentifierTypeStateIssuer
3188787MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rahman.mohammad@covenanthealth.cernerdirect.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060126000531 TN Practitioner - Internal MedicinePractitioner - Geriatric Medicine 9436173903 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians
Covenant Medical Group IncGroup PAC ID 2860305463, 363 clinicians

Practice addresses (Care Compare)

101 Cherokee PL
Suite 107
Loudon, TN 37774-4162
Phone (865) 408-9344

111 Clyde St
Loudon, TN 37774-1600
Phone (865) 458-1554

6600 Nightingale LN
Knoxville, TN 37909-2754
Phone (865) 632-5885

Hospital & facility affiliations

  • Caris Healthcare Hospice, Knoxville, TN, CCN 441585
  • Fort Loudoun Medical Center Hospital, Lenoir City, TN, CCN 440110
  • Parkwest Medical Center Hospital, Knoxville, TN, CCN 440173

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD13686TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group, Inc CurrentSince Aug 1, 2006 Accepting new patients
Covenant Medical Group, Inc. Internal Medicine CurrentSince Aug 1, 2006 Accepting new patients
Loudon Opco LLC Past Accepting new patients

Locations

Dept 888179
Knoxville, TN 37995

111 Clyde St
Loudon, TN 37774
Phone (865) 458-1554

Interoperability endpoints

  • Direct secure messaging: rahman.mohammad@covenanthealth.cernerdirect.com
  • Direct secure messaging: mohammad.rahman.1@19020.direct.athenahealth.com

Organizations & group practices 3

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.

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1700847985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 CLYDE ST",
            "city": "LOUDON",
            "state": "TN",
            "postal_code": "377741566",
            "telephone_number": "865-458-1554",
            "fax_number": "865-458-1762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 CLYDE ST",
            "city": "LOUDON",
            "state": "TN",
            "postal_code": "377741566",
            "telephone_number": "865-458-1554",
            "fax_number": "865-458-1762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAHMAN",
        "first_name": "MOHAMMAD",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD13686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3188787",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rahman.mohammad@covenanthealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "111 Clyde St",
            "city": "Loudon",
            "state": "TN",
            "country_code": "US",
            "postal_code": "377741566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Loudon, TN

Sources for this page

Verify at the official NPI Registry.