NPIMap

Individual provider Active NPI

Mohammed Khorshed Alam Mazumder, MD

  • Gastroenterology Physician
  • Cleveland, OH
National Provider Identifier
1891935250
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
35.123582 Issued in OH
Practice address
2475 E 22ND St Ste 120
Cleveland, OH 44115-3221
Phone
(216) 431-1500
Fax
(216) 431-7701
NPI assigned
Feb 25, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

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 35.123582 OH Primary
Gastroenterology Physician 207RG0100X 250908 NY

Addresses

Primary practice location

2475 E 22ND St Ste 120
Cleveland, OH 44115-3221

Mailing address

PO Box 932127
Cleveland, OH 44193-0008
Phone (216) 431-1500

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address directmedicalarts120@cleveland.ipsmso.com Outreach Professional Services Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20140908002087 OH Practitioner - Gastroenterology 3779764337 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13207 Ravenna Rd
Chardon, OH 44024-7032
Phone (216) 383-0100

13207 Ravenna Rd H
Chardon, OH 44024-7032
Phone (216) 383-0100

158 W Main Rd
Conneaut, OH 44030-2039

1717 W Main St
Suite 203
Newark, OH 43055-1362
Phone (220) 564-2950

3999 Richmond Rd
Beachwood, OH 44122-6046
Phone (216) 383-0100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.15 of 100Reported as apm
Quality
82.31
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
85.98 of 100Reported as group
Quality
75.66
Promoting interoperability
100
Improvement activities
40
Cost
75.38

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy86
Upper gastrointestinal (GI) endoscopy for acid reflux130

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.123582OHMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Primary Care Practices Inc CurrentSince Dec 1, 2022 Accepting new patients
Outreach Professional Services Inc CurrentSince Sep 1, 2020 Accepting new patients
University Primary Care Practices Inc CurrentSince Dec 1, 2022 Accepting new patients
Outreach Professional Services, Inc CurrentSince Sep 1, 2020 Accepting new patients
University Primary Care Practices Inc Gastroenterology Current Accepting new patients
Cogent Healthcare of Minnesota, PC Past Accepting new patients
University Primary Care Practices Past Accepting new patients
Licking Memorial Professional Corp. Past Accepting new patients

Locations

13207 Ravenna Rd
Chardon, OH 44024
Phone (440) 285-5004

2475 E 22nd St
Ste 120
Cleveland, OH 44115
Phone (216) 367-9444

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

Interoperability endpoints

  • Direct secure messaging: mmazumder51821@ehrdirect.uhhospitals.org

Organizations & group practices 9

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 8

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": "1235520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644192000000",
    "number": "1891935250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932127",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930008",
            "telephone_number": "216-431-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2475 E 22ND ST STE 120",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441153221",
            "telephone_number": "216-431-1500",
            "fax_number": "216-431-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZUMDER",
        "first_name": "MOHAMMED",
        "middle_name": "KHORSHED ALAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-25",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OH",
            "license": "35.123582",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "250908",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "directmedicalarts120@cleveland.ipsmso.com",
            "affiliation": "Y",
            "affiliationName": "Outreach Professional Services Inc",
            "address_1": "2475 E 22nd St Ste 120",
            "city": "Cleveland",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441153221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.