Individual provider Active NPI

Imran Ahmed Moinuddin, MD

  • Internal Medicine Physician
  • Cleveland, OH
National Provider Identifier
1861649907
Registry record updated Jul 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35.136489 Issued in OH
Practice address
11100 Euclid Ave
Cleveland, OH 44106-1716
Phone
(440) 613-2858
NPI assigned
Aug 20, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 35.136489 OH
Internal Medicine Physician 207R00000X 35.136489 OH Primary

Addresses

Primary practice location

11100 Euclid Ave
Cleveland, OH 44106-1716

Mailing address

11100 Euclid Ave
Cleveland, OH 44106-1716
Phone (248) 686-6255

Other practice location 1

1001 Covington St
Youngstown, OH 44510-1617
Phone (330) 480-2616

Other identifiers 1

IdentifierTypeStateIssuer
119591300MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, OH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180424000564 MI Practitioner - Internal Medicine 5890963110 Reassigns benefits to 3 organizations
I20190815000103 OH Practitioner - Internal MedicinePractitioner - Hospitalist 5890963110 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.136489OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Center Inc CurrentSince Jul 1, 2021 Accepting new patients
Family Health Center Inc CurrentSince Jul 1, 2021 Accepting new patients
Lakeland Medical Practices Internal Medicine CurrentSince Jul 5, 2018 Accepting new patients
Sound Inpatient Physicians-Michigan, PLLC Internal Medicine CurrentSince Apr 1, 2018 Accepting new patients
Hospitalist Medicine Physicians of Ohio, Professional Corporation Internal Medicine CurrentSince Nov 1, 2019 Accepting new patients
Sound Inpatient Physicians - Michigan, PLLC Internal Medicine CurrentSince Apr 1, 2018 Accepting new patients
Lakeland Medical Practices Internal Medicine CurrentSince Jul 5, 2018 Accepting new patients
Three Lower Counties Community Services, Inc. Past Accepting new patients

Locations

1 Genesys Pkwy
Grand Blanc, MI 48439
Phone (810) 606-5733

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

505 E Alcott St
Kalamazoo, MI 49001
Phone 2693492641 ext. 715

117 W Paterson St
Kalamazoo, MI 49007

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

31 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 428-2417

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

2420 Lake Ave
Ashtabula, OH 44004
Phone (216) 986-2919

1044 Belmont Ave
Youngstown, OH 44504
Phone (330) 480-2182

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.

NPI Registry JSON

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

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593648000000",
    "number": "1861649907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11100 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061716",
            "telephone_number": "248-686-6255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061716",
            "telephone_number": "440-613-2858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Covington St",
            "address_purpose": "LOCATION",
            "city": "Youngstown",
            "state": "OH",
            "postal_code": "445101617",
            "country_code": "US",
            "telephone_number": "330-480-2616",
            "fax_number": "330-480-7979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOINUDDIN",
        "first_name": "IMRAN",
        "middle_name": "AHMED",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-20",
        "last_updated": "2020-07-02",
        "certification_date": "2020-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OH",
            "license": "35.136489",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.136489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119591300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.