NPIMap

Organization Active NPI

Ridge Lake Anesthesia

  • Anesthesiology Physician
  • Memphis, TN
National Provider Identifier
1881810414
Registry record updated Nov 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD0000027884 Issued in TN
Legal business name
RIDGE LAKE ANESTHESIA
Practice address
825 Ridge Lake Blvd
Memphis, TN 38120-9411
Phone
(901) 685-6150
Fax
(901) 685-6454
NPI assigned
Apr 18, 2007
Last updated
Nov 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2010

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

Authorized official

Name
Dr. Susan Mokhtari, M.D.NPI 1225138423
Title
Anesthesiologist
Phone
(901) 685-6150

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD0000027884 TN Primary

Addresses

Primary practice location

825 Ridge Lake Blvd
Memphis, TN 38120-9411

Mailing address

825 Ridge Lake Blvd
Memphis, TN 38120-9411
Phone (901) 685-6150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040721000643 MS Part B Supplier - Clinic/Group Practice 4082600788 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Southaven, MS; Olive Branch, MS

National Provider Directory

National Provider Directory

Locations

7600 Airways Blvd
Ste D
Southaven, MS 38671
Phone (662) 349-7477

5350 Poplar Ave
Ste 900
Memphis, TN 38119
Phone (901) 683-4600

825 Ridge Lake Blvd
Memphis, TN 38120
Phone (901) 685-6150

825 Ridge Lake Blvd
Ste 125
Memphis, TN 38120
Phone (901) 685-6150

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289779200000",
    "number": "1881810414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 RIDGE LAKE BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209411",
            "telephone_number": "901-685-6150",
            "fax_number": "901-685-6454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 RIDGE LAKE BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209411",
            "telephone_number": "901-685-6150",
            "fax_number": "901-685-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGE LAKE ANESTHESIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2010-11-15",
        "status": "A",
        "authorized_official_last_name": "MOKHTARI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "ANESTHESIOLOGIST",
        "authorized_official_telephone_number": "901-685-6150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "MD0000027884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.