Active NPI
Gholam Reza Motakhaveri, MD
- Internal Medicine Physician
- Biloxi, MS
National Provider Identifier
1790747269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 15627
- Practice address
- 147 Reynoir Street
Suite 204
Biloxi, MS 39530 - Phone
- (228) 374-2051
- Fax
- (228) 374-5741
- NPI assigned
- Apr 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 15627 | MS | Primary |
Addresses
Primary practice location
147 Reynoir Street
Suite 204
Biloxi, MS 39530
Mailing address
147 Reynoir Street
Suite 204
Biloxi, MS 39530
Phone (228) 374-2051
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0118697 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- University of Iowa, RJ & L Carver College of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
147 Reynoir St
Suite 101
Biloxi, MS 39530-4119
Phone (228) 374-2051
Hospital & facility affiliations
- Saads Home Nursing of Ms
- Enhabit Home Health of the Gulf Coast
- Deaconess Homecare- Region I
- Memorial Hospital Biloxi
- Singing River Gulfport
- Memorial Hospital at Gulfport
- Singing River Health System
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15627 | MS | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Biloxi Internal Medicine Clinic PA | Internal Medicine | Current | Accepting new patients |
| Biloxi Hma LLC | Internal Medicine | Past | Accepting new patients |
Locations
147 Reynoir St
Ste 101
Biloxi, MS 39530
Phone (228) 374-2051
150 Reynoir St
Biloxi, MS 39530
Phone (228) 432-7817
147 Reynoir St
Ste 204
Biloxi, MS 39530
Phone (228) 374-6296
Organizations & group practices 2
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.
-
- Internal Medicine Physician
- Biloxi, MS
- NPI 1962464438
-
- Internal Medicine Physician
- Biloxi, MS
- NPI 1891677555
Hospital & facility affiliations 66
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Gulfport, MS
- NPI 1013142066
-
- General Acute Care Hospital
- Gulfport, MS
- NPI 1073606901
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Gulfport, MS
- NPI 1184956815
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569801600000",
"number": "1790747269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "147 REYNOIR STREET",
"address_2": "SUITE 204",
"city": "BILOXI",
"state": "MS",
"postal_code": "39530",
"telephone_number": "228-374-2051",
"fax_number": "228-374-5741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "147 REYNOIR STREET",
"address_2": "SUITE 204",
"city": "BILOXI",
"state": "MS",
"postal_code": "39530",
"telephone_number": "228-374-2051",
"fax_number": "228-374-5741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOTAKHAVERI",
"first_name": "GHOLAM",
"middle_name": "REZA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-03",
"last_updated": "2019-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MS",
"license": "15627",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0118697",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Biloxi, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2019; 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.