NPIMap

Organization Active NPI

MD Homecare LLC

  • Health Service Psychologist
  • Phoenix, AZ
National Provider Identifier
1720524333
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service PsychologistTaxonomy code 103TH0100X
Legal business name
MD HOMECARE LLC
Practice address
9225 N 3Rd St Ste 102
Phoenix, AZ 85020-2455
Phone
(602) 362-2983
Fax
(480) 565-4552
NPI assigned
Jan 6, 2017
Reactivated
Jul 5, 2023
Last updated
Jul 5, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MD HOMECARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Authorized official

Name
Mohamed KhalilNPI 1851950521
Title
Ceo
Phone
(602) 362-2983

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
Nursing Care Agency 251J00000X
Health Service Psychologist 103TH0100X Primary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

9225 N 3Rd St Ste 102
Phoenix, AZ 85020-2455

Mailing address

9225 N 3Rd St Ste 102
Phoenix, AZ 85020-2455
Phone (602) 362-2983

Other identifiers 2

IdentifierTypeStateIssuer
290653MedicaidAZ
1720524333OtherAZNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170410001831 AZ Part B Supplier - Clinic/Group Practice 8325324114 Receives reassigned benefits from 12 practitioners
Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory
Part of
MD Homecare LLC

Locations

1437 W Auto Dr
Tempe, AZ 85284
Phone (602) 362-2983

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21147/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1483660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1720524333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9225 N 3RD ST STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850202455",
            "telephone_number": "602-362-2983",
            "fax_number": "480-565-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9225 N 3RD ST STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850202455",
            "telephone_number": "602-362-2983",
            "fax_number": "480-565-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD HOMECARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MD HOMECARE, LLC",
        "enumeration_date": "2017-01-06",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "deactivation_date": "2023-06-02",
        "reactivation_date": "2023-07-05",
        "status": "A",
        "authorized_official_last_name": "KHALIL",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-362-2983"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290653",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1720524333",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.