NPIMap

Individual provider Active NPI

Ellis Mossaded, M.D.

  • General Practice Physician
  • Gainesville, GA
National Provider Identifier
1790195261
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
74500 Issued in GA
Practice address
2200 Old Hamilton PL
Gainesville, GA 30507-7892
Phone
(770) 532-2066
NPI assigned
May 5, 2014
Last updated
Apr 8, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 74500 GA Primary

Addresses

Primary practice location

2200 Old Hamilton PL
Gainesville, GA 30507-7892

Mailing address

6065 Roswell Rd
Sandy Springs, GA 30328-4011
Phone (770) 231-3100

Other names 1

  • Shahriar Mossaded Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, GA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140728001062 NY Practitioner - General Practice 1658597695 Reassigns benefits to 2 organizations
I20230804003488 GA Practitioner - General Practice 1658597695 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Complexcare Medical Group Southeast H PLLCGroup PAC ID 9830693993, 12 clinicians
Theoria MedicalGroup PAC ID 5395098339, 317 clinicians

Practice addresses (Care Compare)

2200 Old Hamilton PL
Gainesville, GA 30507-7892
Phone (770) 532-2066

4608 Lawrenceville Hwy
Tucker, GA 30084-2903
Phone (248) 660-1220

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
74500GAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Complexcare Medical Group Southeast H PLLC CurrentSince Jun 7, 2025 Accepting new patients
Essen Medical Associates, PC CurrentSince Apr 1, 2014 Accepting new patients
Theoria Medical CurrentSince Jul 8, 2024 Accepting new patients
Essen Medical Associates, PC CurrentSince Apr 1, 2014 Accepting new patients
CTD Network LLC General Practice CurrentSince Jul 1, 2023 Accepting new patients
Synergy Medical Centers, LLC. Specialist PastSince Mar 25, 2013 Accepting new patients
Hamilton Mill Associates, L.P. Past Accepting new patients
Meadowbrook Operator LLC Past Accepting new patients
Complexcare Medical Group Midwest M PLLC Past Accepting new patients
Arrowhead Operator LLC Past Accepting new patients
Coliseum Drive Associates LLC Past Accepting new patients

Locations

1155 W College St
Bainbridge, GA 39819
Phone (229) 243-0931

2200 Old Hamilton Pl
Gainesville, GA 30507
Phone (770) 532-2006

4000 Village View Dr
Gainesville, GA 30506
Phone (678) 450-3000

11605 Abercorn St
Savannah, GA 31419
Phone (615) 619-2585

4608 Lawrenceville Hwy
Tucker, GA 30084
Phone (770) 491-9444

7300 Lester Rd
Union City, GA 30291
Phone (770) 703-2604

41800 W 11 Mile Rd
Novi, MI 48375
Phone (248) 282-5044

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

2015 Grand Concourse
Bronx, NY 10453
Phone (718) 294-6200

2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400

8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Willowbrooke Court at Lanier Village EstatesGainesville, GA, CCN 115687 Skilled nursing facility Adp of the SNF Mar 1, 2025
Reliant RehabilitationJonesboro, GA, CCN 115539 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2025
Oct 1, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1399248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1790195261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6065 ROSWELL RD",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303284011",
            "telephone_number": "770-231-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 OLD HAMILTON PL",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305077892",
            "telephone_number": "770-532-2066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSSADED",
        "first_name": "ELLIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-05",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "74500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHAHRIAR",
            "last_name": "MOSSADED",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.