Mohammed Shujauddin Ahmed, D.O.
Individual provider Active NPI Nephrology Physician · Bolingbrook, IL
NPI 1962588061 · NPPES record last updated Oct 22, 2020
Key facts
- NPI
- 1962588061
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- 036113939 (IL)
- Practice address
- 396 Remington Blvd Ste 140
Bolingbrook, IL 60440-4311 - Phone
- (630) 495-9356
- Fax
- (630) 495-9357
- NPI assigned
- Oct 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nephrology
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Nephrology Associates of Northern Illinois LTD
Practice addresses (Care Compare)
120 Spalding Dr
Suite 410
Naperville, IL 60540-6558
Phone (630) 690-1220
396 Remington Blvd
Suite 140
Bolingbrook, IL 60440-4311
Phone (630) 495-9356
Hospital & facility affiliations
- Usrc Bolingbrook
- FMC - Bolingbrook Dialysis
- Uchicago Medicine Adventhealth Bolingbrook
- Uchicago Medicine Adventhealth Hinsdale
- Advocate Good Samaritan Hospital
- Edward Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080708000650 | IL | Practitioner - Nephrology |
8224119227 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-113939 | IL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nani Elk Grove | Nephrology | Current |
Accepting new patients |
| Nephrology Associates of Northern Illinois, LTD. | Nephrology | Current |
Accepting new patients |
| Nephrology Associates of Northern Illinois, LTD. | Nephrology | Current |
Accepting new patients |
| Adventist Health Partners, Inc | Past | Accepting new patients |
Locations
396 Remington Blvd
Ste 231
Bolingbrook, IL 60440
Phone (630) 312-4301
396 Remington Blvd
Ste 140
Bolingbrook, IL 60440
Phone (630) 495-9356
3223 W 63rd St
Chicago, IL 60629
Phone (773) 735-4884
901 Biesterfield Rd
Ste 310
Elk Grove Vlg, IL 60007
Phone (847) 437-7070
911 N Elm St
Ste 102
Hinsdale, IL 60521
Phone (630) 495-9356
120 Spalding Dr
Ste 410
Naperville, IL 60540
Phone (630) 369-0780
120 W 22nd St
Oak Brook, IL 60523
120 W 22nd St
Ste 200
Oak Brook, IL 60523
Phone (630) 575-5000
Interoperability endpoints
- mahmed49680@direct.acumenmd.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036-113939 | IL | |
| Nephrology Physician | 207RN0300X | 036113939 | IL | Yes |
Addresses
Primary practice location
396 Remington Blvd Ste 140
Bolingbrook, IL 60440-4311
Mailing address
120 W 22ND St Ste 200
Oak Brook, IL 60523-1563
Phone (630) 575-5000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 400280 | Other | IL | MEDICARE GROUP PTAN |
| 036113939 | Medicaid | IL |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | credentialing@nephdocs.com |
Other providers in Bolingbrook, IL
- Mahrukh M Afridi
- Agape Home Health of Illinois, Inc.
- Agape Solutions Inc
- Saira Manahil Ahmad
- Irma Ahmed
- Air Angels, Inc.
- Manju M Akhand
- Naveed Akhtar
- Youssef E Akl
- Ghiath Al Kassar
All providers in Bolingbrook, IL · Nephrology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.