NPIMap

Individual provider Active NPI

Mohammad Mujeebuddin, MD

  • Internal Medicine Physician
  • Hopewell, VA
National Provider Identifier
1891764379
Registry record updated Feb 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101042591 Issued in VA
Practice address
1012 Winston Churchill Dr
Hopewell, VA 23860-5141
Phone
(804) 458-8583
Fax
(804) 541-2724
NPI assigned
Mar 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101042591 VA Primary

Addresses

Primary practice location

1012 Winston Churchill Dr
Hopewell, VA 23860-5141

Mailing address

1012 Winston Churchill Dr
Hopewell, VA 23860-5141
Phone (804) 458-8583

Other identifiers 1

IdentifierTypeStateIssuer
006040853MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20040907000870 VA Practitioner - Internal Medicine 0446226963 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Twin River Medical Clinic PCGroup PAC ID 7517923790, 8 clinicians
Columbia-HCA John Randolph, IncGroup PAC ID 0244206753, 7 clinicians

Practice addresses (Care Compare)

1012 Winston Churchill Dr
Hopewell, VA 23860-5141
Phone (804) 458-8583

411 W Randolph Rd
Hopewell, VA 23860-2938
Phone (804) 541-1600

Hospital & facility affiliations

  • Nayar Health Care LLC Home health agency, Ashland, VA, CCN 497743
  • HCA Virginia Healthcare at Home Home health agency, North Chesterfield, VA, CCN 497625
  • Amedisys Home Health Home health agency, Midlothian, VA, CCN 497538
  • John Randolph Medical Center Hospital, Hopewell, VA, CCN 490020
  • Bon Secours Southside Medical Center Hospital, Petersburg, VA, CCN 490067

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101042591VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia/HCA John Randolph, Inc. CurrentSince Apr 24, 2016 Accepting new patients
Twin River Medical Clinic PC Internal Medicine CurrentSince Aug 22, 1988 Accepting new patients

Locations

411 W Randolph Rd
Hopewell, VA 23860
Phone (804) 452-3624

1012 Winston Churchill Dr
Hopewell, VA 23860
Phone (804) 458-8583

Interoperability endpoints

  • Direct secure messaging: twinriversmedicalclinicpc.mohammadmujeebuddin@119949.advancedmd-direct.com

Organizations & group practices 2

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 10

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": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392681600000",
    "number": "1891764379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 WINSTON CHURCHILL DR",
            "city": "HOPEWELL",
            "state": "VA",
            "postal_code": "238605141",
            "telephone_number": "804-458-8583",
            "fax_number": "804-541-2724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 WINSTON CHURCHILL DR",
            "city": "HOPEWELL",
            "state": "VA",
            "postal_code": "238605141",
            "telephone_number": "804-458-8583",
            "fax_number": "804-541-2724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUJEEBUDDIN",
        "first_name": "MOHAMMAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2014-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101042591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006040853",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hopewell, VA

Sources for this page

Verify at the official NPI Registry.