Mohammed Shoaib Jameel Kidwai, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD433668 Issued in PA

Practice address

333 E City Ave Ste PL50
Bala Cynwyd, PA 19004-1505

Phone

(610) 667-1115

NPI assigned

Dec 18, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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

Internal Medicine

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of New Jersey Omb Centralized PayrollGroup PAC ID 6406742592, 129 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• State of New Jersey Omb Centralized Payroll

  dba Trenton Psychiatric Hospital

  • Psychiatric Hospital
  • Trenton, NJ
  • NPI 1467552240
  Medicare reassignment Care Compare group NPD
• Mainline Health Associates

  • Clinic/Center
  • Bala Cynwyd, PA
  • NPI 1104167022
  NPD (past) Authorized official
• State of New Jersey Omb Centralized Payroll

  dba Greystone Park Psychiatric Hospital

  • Psychiatric Hospital
  • Morris Plains, NJ
  • NPI 1336221878
  NPD

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

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1790969319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4233 REMO CRESCENT RD",
            "city": "BENSALEM",
            "state": "PA",
            "postal_code": "190202976",
            "telephone_number": "215-639-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 E CITY AVE STE PL50",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041505",
            "telephone_number": "610-667-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDWAI",
        "first_name": "MOHAMMED",
        "middle_name": "SHOAIB JAMEEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-18",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.134997",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "TP985",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "35.134997",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "KY",
            "license": "TP985",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD433668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph S Kenney III, D.O.
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• Anika Nurin Khan, PHD
• Meher S Khan, MD
• Tarik Sharif Khan, FNP
• Timothy Kim, OD
• Kinderbuch US P C
• Kinetic Home Care, LLC
• King RX, LLC
• Adrian King

• Internal Medicine Physician in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; 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.