NPIMap

Organization Active NPI

Khakwani and Mohammad Medical PC

Doing business as PDS Medical Group Ellsworth

  • Family Medicine Physician
  • Mesa, AZ
National Provider Identifier
1912805441
Registry record updated Oct 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KHAKWANI AND MOHAMMAD MEDICAL PC
Doing business as
PDS Medical Group Ellsworth
Practice address
5143 S Ellsworth Rd Ste 101B
Mesa, AZ 85212-0173
Phone
(480) 696-5594
Fax
(480) 448-1577
NPI assigned
Oct 26, 2026
Last updated
Oct 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2026

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

Authorized official

Name
Sam Richard Roy
Title
Credentialing Manager
Phone
(469) 868-0730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5143 S Ellsworth Rd Ste 101B
Mesa, AZ 85212-0173

Mailing address

PO Box 660046
Dallas, TX 75266-0046

Other names 1

  • PDS Medical Group Ellsworth Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Khakwani and Mohammad Med6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5143 S Ellsworth Rd
Ste 101B
Mesa, AZ 85212

NPI Registry JSON

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

{
    "created_epoch": "1792972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792972800000",
    "number": "1912805441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660046",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752660046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5143 S ELLSWORTH RD STE 101B",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852120173",
            "telephone_number": "480-696-5594",
            "fax_number": "480-448-1577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHAKWANI AND MOHAMMAD MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-26",
        "last_updated": "2026-10-26",
        "certification_date": "2026-10-26",
        "status": "A",
        "authorized_official_last_name": "ROY",
        "authorized_official_first_name": "SAM RICHARD",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "469-868-0730"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDS Medical Group Ellsworth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.