NPIMap

Individual provider Active NPI

Ghulam Mujtaba, MD.

  • Gastroenterology Physician
  • Newark, OH
National Provider Identifier
1821277187
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
35.097038 Issued in OH
Practice address
60 Messimer Dr
Newark, OH 43055-3692
Phone
(740) 326-6552
Fax
(740) 326-6897
NPI assigned
Nov 2, 2007
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 036144414 IL
Gastroenterology Physician 207RG0100X 35.097038 OH Primary

Addresses

Primary practice location

60 Messimer Dr
Newark, OH 43055-3692

Mailing address

60 Messimer Dr
Newark, OH 43055-3692
Phone (740) 326-6552

Other practice location 1

503 Wooster Rd
Mount Vernon, OH 43050-1486
Phone (740) 326-6552

Other practice location 2

1320 West Main Street
Newark, OH 43055
Phone (220) 564-4137

Other practice location 3

1320 West Main Street
Newark, OH 43055
Phone (220) 564-4137

Other identifiers 1

IdentifierTypeStateIssuer
0051080MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, NV2 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
I20110713000875 OH Practitioner - GastroenterologyPractitioner - Internal Medicine 2860578887 Reassigns benefits to 1 organization
I20180619001565 NV Practitioner - Internal MedicinePractitioner - Gastroenterology 2860578887 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osama Haikal MD LTDGroup PAC ID 0840279915, 10 clinicians

Practice addresses (Care Compare)

2136 E Desert Inn Rd
Suite a
Las Vegas, NV 89169-3247
Phone (702) 734-0505

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.49 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
74.96

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy215
Upper gastrointestinal (GI) endoscopy for acid reflux244

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036144414ILMDGastroenterology Physician
35.097038OHMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Health Professionals of Holmes County, Inc CurrentSince Nov 17, 2024 Accepting new patients
Digestive Disease Center-Green Valley LLC Gastroenterology Current Accepting new patients
Pahrump Gastroenterology LLC PastSince May 21, 2018 Accepting new patients
Dignity Health Past Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients
Digestive Disease Center Past Accepting new patients

Locations

1647 E Windmill Ln
Ste 100
Las Vegas, NV 89123
Phone (702) 914-6555

981 Wooster Rd
Millersburg, OH 44654
Phone (330) 674-1015

Organizations & group practices 11

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 3

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": "1193961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1821277187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MESSIMER DR",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430553692",
            "telephone_number": "740-326-6552",
            "fax_number": "740-326-6897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MESSIMER DR",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430553692",
            "telephone_number": "740-326-6552",
            "fax_number": "740-326-6897"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "503 Wooster Rd",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "OH",
            "postal_code": "430501486",
            "country_code": "US",
            "telephone_number": "740-326-6552",
            "fax_number": "740-326-6897",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1320 West Main Street",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "OH",
            "postal_code": "43055",
            "country_code": "US",
            "telephone_number": "220-564-4137",
            "fax_number": "220-564-4761",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1320 West Main Street",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "OH",
            "postal_code": "43055",
            "country_code": "US",
            "telephone_number": "220-564-4137",
            "fax_number": "220-564-4761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUJTABA",
        "first_name": "GHULAM",
        "name_prefix": "Dr.",
        "credential": "MD.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-02",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036144414",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OH",
            "license": "35.097038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0051080",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, OH

Sources for this page

Verify at the official NPI Registry.