Mohammad Ahmad Al Efishat, M.D.

Key facts

NPI

1710312400

Entity type

Individual (NPI type 1)

Primary specialty

Surgery Physician 208600000X

License

329841 (LA)

Practice address

7777 Hennessy Blvd Ste 612
Baton Rouge, LA 70808-4366

Phone

(225) 769-5656

Fax

(225) 766-6996

NPI assigned

Sep 12, 2013

Sex

Male

Sole proprietor

No

Organizations & group practices 5

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.

• Our Lady of the Lake Physician Group LLC Internal Medicine Physician · Baton Rouge, LA · NPI 1033494943
  Medicare reassignment Care Compare group NPD LA · SURGERY
• Our Lady of the Lake Physician Group, LLC Rural Health Clinic/Center · Maurepas, LA · NPI 1134152630
  Care Compare group
• Our Lady of the Lake Physician Group LLC Comprehensive Outpatient Rehabilitation Facility (CORF) · Baton Rouge, LA · NPI 1235912502
  NPD
• Our Lady of the Lake Hospital Inc. General Acute Care Hospital · Baton Rouge, LA · NPI 1366436123
  NPD (past)
• Our Lady of the Lake Physician Group LLC Hematology & Oncology Physician · Baton Rouge, LA · NPI 1184671455
  NPD (past) SURGERY

Hospital & facility affiliations 2

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

• Our Lady of the Lake Hospital Inc. General Acute Care Hospital · Baton Rouge, LA · NPI 1366436123
  Care Compare affiliation Hospital
• St Francis Medical Center, Inc General Acute Care Hospital · Monroe, LA · NPI 1295723229
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

General Surgery

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Our Lady of the Lake Physician Group LLC (637 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Our Lady of the Lake Regional Medical Center Hospital · Baton Rouge, LA · CCN 190064
• Fmol Health St Francis Hospital · Monroe, LA · CCN 190125

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/R4/
• Direct secure messaging: malefishat79899@direct.hopkinsmedicine.org
• Direct secure messaging: malefishat3028994@direct.casso.us.com

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 27, 2022.

{
    "created_epoch": "1378944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1710312400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 S SHERWOOD FOREST BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166038",
            "telephone_number": "225-769-5656",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 HENNESSY BLVD STE 612",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084366",
            "telephone_number": "225-769-5656",
            "fax_number": "225-766-6996"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 N Wolfe St",
            "address_2": "The Johns Hopkins Hospital- Blalock 665",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212870005",
            "country_code": "US",
            "telephone_number": "667-208-7327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AL EFISHAT",
        "first_name": "MOHAMMAD",
        "middle_name": "AHMAD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-12",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "329841",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "malefishat3028994@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "malefishat3028994@direct.casso.us.com",
            "address_1": "7777 Hennessy Blvd Ste 612",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708084366",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "7777 Hennessy Blvd Ste 612",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708084366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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All providers in Baton Rouge, LA · Surgery Physician in Louisiana