Mohammad Farooque, M.D., PH.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME100550 Issued in FL

Practice address

10175 Fortune Pkwy
Suite #1106
Jacksonville, FL 32256-6746

Phone

(904) 379-5928

Fax

(904) 379-5967

NPI assigned

Jul 21, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Craft Behavioral Health, LLCGroup PAC ID 8729115043, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Craft Behavioral Health, LLC

  • Psychiatry Physician
  • Jacksonville, FL
  • NPI 1639491632
  Medicare reassignment Care Compare group NPD Authorized official
• Wekiva Springs Center LLC

  • Psychiatric Hospital
  • Jacksonville, FL
  • NPI 1942471065

  Psychiatry

  Medicare reassignment NPD
• Craft Behavioral Health Clinic

  • Technician
  • Jacksonville, FL
  • NPI 1184308108
  NPD

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395100800000",
    "number": "1730100587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10175 FORTUNE PKWY",
            "address_2": "SUITE #1106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566746",
            "telephone_number": "904-379-5928",
            "fax_number": "904-379-5967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10175 FORTUNE PKWY",
            "address_2": "SUITE #1106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566746",
            "telephone_number": "904-379-5928",
            "fax_number": "904-379-5967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAROOQUE",
        "first_name": "MOHAMMAD",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2014-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": "2005013889",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME100550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "565587892A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1455P",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011903-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Farnham & Farnham PA
• Ian Mackenzie Farnham, D.D.S.
• Kristen Farnham, RDN
• Crystal Farnsworth, RN IBCLC
• Moosa Muhammad Farooqi
• Jennifer Michelle Farr, BCABA
• Mary Louise Farr, ARNP
• Francis A Farraye, M.D.
• Raquel Myra Farrell-Kirk, ATR-BC
• Alison Farrell

• Psychiatry Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; 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.

Verify at the official NPI Registry.