Fayyaz Mahmood, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD16510 Issued in OR

Practice address

24988 SE Stark St
Ste 300
Gresham, OR 97030-8322

Phone

(503) 674-5818

Fax

(503) 674-6709

NPI assigned

Aug 22, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• MTH Clinic PC

  • Internal Medicine Physician
  • Gresham, OR
  • NPI 1558354522
  NPD Authorized official

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416182400000",
    "number": "1790777050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24988 SE STARK ST",
            "address_2": "STE 300",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970308322",
            "telephone_number": "503-674-5818",
            "fax_number": "503-674-6709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24988 SE STARK ST",
            "address_2": "STE 300",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970308322",
            "telephone_number": "503-674-5818",
            "fax_number": "503-674-6709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHMOOD",
        "first_name": "FAYYAZ",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2014-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD16510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010020",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kate Madden
• Annastasia Madison
• Debra Magnani, DPT
• Cecilia Sophia Mah
• Kailea Jay Hart Mahler, SLP
• Kevin Mahon
• Madalena Thuy-Lan Mai
• Main Psychology Inc
• Main Street Dental
• Joyce Maina

• Internal Medicine Physician in Gresham, OR
• Providers in Gresham, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.