NPIMap

Individual provider Active NPI

Mohammed Mominul Islam, DO

  • Internal Medicine Physician
  • Montgomeryville, PA
National Provider Identifier
1942460670
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS014967 Issued in PA
Practice address
589 Bethlehem Pike Ste 400
Montgomeryville, PA 18936-9746
Phone
(267) 753-9643
Fax
(267) 339-6525
NPI assigned
Jun 16, 2008
Last updated
Mar 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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 OS014967 PA Primary

Addresses

Primary practice location

589 Bethlehem Pike Ste 400
Montgomeryville, PA 18936-9746

Mailing address

589 Bethlehem Pike Ste 400
Montgomeryville, PA 18936-9746
Phone (267) 753-9643

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20100526000072 PA Practitioner - Internal Medicine 6305975640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rowan University School of Osteopathic Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

589 Bethlehem Pike
Suite 400
Montgomeryville, PA 18936-9746
Phone (267) 753-9643

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS014967PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Orchard Medicine PC Internal Medicine CurrentSince Jul 1, 2018 Accepting new patients
Gwynedd Healthcare LLC Past Accepting new patients
701 Lansdale Operating, LLC Past Accepting new patients
640 Bethlehem Pike Operations LLC Past Accepting new patients

Locations

589 Bethlehem Pike
Ste 400
Montgomeryvle, PA 18936
Phone (267) 227-1811

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St. Mary Center for Rehabilitation & HealthcareLansdale, PA, CCN 395621 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2019
Oct 1, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1213574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1942460670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "589 BETHLEHEM PIKE STE 400",
            "city": "MONTGOMERYVILLE",
            "state": "PA",
            "postal_code": "189369746",
            "telephone_number": "267-753-9643",
            "fax_number": "267-339-6525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "589 BETHLEHEM PIKE STE 400",
            "city": "MONTGOMERYVILLE",
            "state": "PA",
            "postal_code": "189369746",
            "telephone_number": "267-753-9643",
            "fax_number": "267-339-6525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISLAM",
        "first_name": "MOHAMMED",
        "middle_name": "MOMINUL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-16",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS014967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomeryville, PA

Sources for this page

Verify at the official NPI Registry.