Individual provider Active NPI

Mohammad Q Mohyuddin, AA

  • Anesthesiologist Assistant
  • Tallahassee, FL
National Provider Identifier
1760212989
Registry record updated Apr 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
AA1055 Issued in FL
Practice address
2616 Antietam TRL
Tallahassee, FL 32312-4841
Phone
(850) 241-5868
NPI assigned
Aug 2, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X PENDING MO
Anesthesiologist Assistant 367H00000X AA1055 FL Primary

Addresses

Primary practice location

2616 Antietam TRL
Tallahassee, FL 32312-4841

Mailing address

339 Consort Dr
Ballwin, MO 63011-4439
Phone (636) 386-9224

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250212000981 MO Practitioner - Anesthesiology Assistant 9436689023 Reassigns benefits to 1 organization
I20250415000614 FL Practitioner - Anesthesiology Assistant 9436689023 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesiology Associates of Tallahassee IncGroup PAC ID 3476446014, 133 clinicians

Practice addresses (Care Compare)

2626 Capital Medical Blvd
Tallahassee, FL 32308-4402
Phone (954) 939-5000

Hospital & facility affiliations

  • Tallahassee Memorial Healthcare Hospital, Tallahassee, FL, CCN 100135
  • HCA Florida Capital Hospital Hospital, Tallahassee, FL, CCN 100254

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
AA1055FLMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Western Anesthesiology Associates, Inc. CurrentSince Jan 10, 2025 Accepting new patients
Anesthesiology Associates of Tallahassee Inc CurrentSince Apr 3, 2025 Accepting new patients
Anesthesiology Associates of Tallahassee Inc CurrentSince Apr 3, 2025 Accepting new patients
Anesthesiology Associates of Tallahassee Inc Past Accepting new patients

Locations

2629 Welaunee Blvd
Tallahassee, FL 32308
Phone (850) 877-4688

1300 Miccosukee Rd
Tallahassee, FL 32308
Phone (850) 431-1155

2626 Capital Medical Blvd
Tallahassee, FL 32308
Phone (850) 325-5000

2173 Centerville Pl
Ste A
Tallahassee, FL 32308

339 Consort Dr
Ballwin, MO 63011
Phone (636) 386-7222

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

Organizations & group practices 4

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 2

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": "1722556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744243200000",
    "number": "1760212989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 CONSORT DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114439",
            "telephone_number": "636-386-9224",
            "fax_number": "636-386-7679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2616 ANTIETAM TRL",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323124841",
            "telephone_number": "850-241-5868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHYUDDIN",
        "first_name": "MOHAMMAD",
        "middle_name": "Q",
        "name_prefix": "Mr.",
        "credential": "AA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-02",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "MO",
            "license": "PENDING",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "FL",
            "license": "AA1055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.