Abolghasem Marco Rezaei, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

23655 Issued in OK

Practice address

4121 W Gore Blvd
Lawton, OK 73505-6336

Phone

(580) 699-5511

Fax

(580) 699-5519

NPI assigned

Apr 10, 2006

Last updated

Mar 27, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

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.

• Abolghasem Rezaei MD PC

  dba Family Medicine & Urgent Care

  • Family Medicine Physician
  • Lawton, OK
  • NPI 1366538183
  Authorized official Same address or phone

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616803200000",
    "number": "1811950942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056336",
            "telephone_number": "580-699-5511",
            "fax_number": "580-699-5519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056336",
            "telephone_number": "580-699-5511",
            "fax_number": "580-699-5519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZAEI",
        "first_name": "ABOLGHASEM",
        "middle_name": "MARCO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2021-03-27",
        "certification_date": "2021-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "23655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200097020B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "I52055",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1811950942",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Judith Ann Reynolds, CPNP, MSN
• Phillip Anthony Reza, PRACTICAL NURSE
• RGH Eye Clinic PLLC
• Carol S Rhodes
• Monica Rhodes, APRN-CNS
• Amber Ricard
• Richard Campbell MD Inc

• Family Medicine Physician in Lawton, OK
• Providers in Lawton, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.