NPIMap

Individual provider Active NPI

Timur-Metin Mujdaba, M.D.

  • Psychiatry Physician
  • Cranston, RI
National Provider Identifier
1831570092
Registry record updated Aug 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD16684 Issued in RI
Practice address
111 Howard Ave
Cranston, RI 02920-3001
Phone
(401) 712-3170
NPI assigned
Jun 14, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD16684 RI Primary

Addresses

Primary practice location

111 Howard Ave
Cranston, RI 02920-3001

Mailing address

111 Howard Ave
Cranston, RI 02920-3001
Phone (401) 712-3170

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address metin.mujdaba.ctr@bhddh.ri.gov Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191104002399 RI Practitioner - PsychiatryPractitioner - Internal Medicine 3476885807 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prospect Chartercare Sjhsri LLCGroup PAC ID 7315179314, 32 clinicians

Practice addresses (Care Compare)

2 Wake Robin Rd
Fatima Hospital Wound Care Group
Lincoln, RI 02865-4295
Phone (401) 334-3830

Hospital & facility affiliations

  • Our Lady of Fatima Hospital Hospital, North Providence, RI, CCN 410005

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Chartercare Sjhsri, LLC Psychiatry CurrentSince Mar 27, 2023 Accepting new patients
Prospect Chartercare Sjhsri, LLC CurrentSince Mar 27, 2023 Accepting new patients
Chartercare Our Lady of Fatima Hospital Psychiatry CurrentSince May 28, 2025 Accepting new patients
Chartercare Our Lady of Fatima Hospital CurrentSince May 28, 2025 Accepting new patients
Prospect Chartercare RWMC, LLC CurrentSince Mar 27, 2023 Accepting new patients
Prospect Chartercare RWMC, LLC CurrentSince Mar 27, 2023 Accepting new patients
Roger Williams Medical Center Past Accepting new patients

Locations

2 Wake Robin Rd
Lincoln, RI 02865
Phone (401) 333-1747

200 High Service Ave
North Providence, RI 02904
Phone (401) 456-3000

825 Chalkstone Ave
Providence, RI 02908
Phone (401) 456-2000

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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": "1434240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1831570092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HOWARD AVE",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029203001",
            "telephone_number": "401-712-3170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 HOWARD AVE",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029203001",
            "telephone_number": "401-712-3170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUJDABA",
        "first_name": "TIMUR-METIN",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-14",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "RI",
            "license": "MD16684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "metin.mujdaba.ctr@bhddh.ri.gov",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "111 Howard Ave",
            "city": "Cranston",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029203001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cranston, RI

Sources for this page

Verify at the official NPI Registry.