NPIMap

Organization Active NPI

Leading Healthcare Clinic of Goodyear LLC

  • Internal Medicine Physician
  • Goodyear, AZ
National Provider Identifier
1902448566
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LEADING HEALTHCARE CLINIC OF GOODYEAR LLC
Practice address
13555 W McDowell Rd Ste 205
Goodyear, AZ 85395-2626
Phone
(623) 295-1190
Fax
(602) 429-8595
NPI assigned
Oct 15, 2019
Last updated
Mar 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

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

Authorized official

Name
Dr. Mohammad NasserNPI 1376835157
Title
Ceo
Phone
(313) 485-5680

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 7

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU
Family Nurse Practitioner 363LF0000X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Family Medicine Physician 207Q00000X NU
Adult Medicine Physician 207QA0505X NU
Internal Medicine Physician 207R00000X NU Primary
Hospitalist Physician 208M00000X NU

Addresses

Primary practice location

13555 W McDowell Rd Ste 205
Goodyear, AZ 85395-2626

Mailing address

13555 W McDowell Rd Ste 205
Goodyear, AZ 85395-2626

Other identifiers 1

IdentifierTypeStateIssuer
005817MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200415002967 AZ Part B Supplier - Clinic/Group Practice 7315377371 Receives reassigned benefits from 33 practitioners
Practice locations: Peoria, AZ; Sun City, AZ; Goodyear, AZ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2173569Leading Healthcare Clinic13555 W McDowell Rd Ste 205, Goodyear, AZ 85395Certificate of waiverOct 14, 2027

National Provider Directory

National Provider Directory

Locations

1200 S Castle Dome Ave
Yuma, AZ 85365

Practitioners & affiliated clinicians

Practitioners 103

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.

View all 103

NPI Registry JSON

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

{
    "created_epoch": "1571097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1902448566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13555 W MCDOWELL RD STE 205",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13555 W MCDOWELL RD STE 205",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952626",
            "telephone_number": "623-295-1190",
            "fax_number": "602-429-8595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEADING HEALTHCARE CLINIC OF GOODYEAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-15",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "NASSER",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "313-485-5680",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005817",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.