Mohammed Adel Mohammed, CCP, LP, MPS

Primary specialty

PerfusionistTaxonomy code 242T00000X

License

214000415 Issued in IL

Practice address

959 S Indiana Ave
Sellersburg, IN 47172-1639

Phone

(877) 234-3266

Fax

(877) 455-1021

NPI assigned

Jul 5, 2022

Last updated

Jul 5, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1656979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656979200000",
    "number": "1982337358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2773",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471312773",
            "telephone_number": "812-736-2211",
            "fax_number": "877-455-1021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "959 S INDIANA AVE",
            "city": "SELLERSBURG",
            "state": "IN",
            "postal_code": "471721639",
            "telephone_number": "877-234-3266",
            "fax_number": "877-455-1021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAMMED",
        "first_name": "MOHAMMED",
        "middle_name": "ADEL",
        "credential": "CCP, LP, MPS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-05",
        "last_updated": "2022-07-05",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "242T00000X",
            "taxonomy_group": "",
            "desc": "Perfusionist",
            "state": "WI",
            "license": "214",
            "primary": false
        },
        {
            "code": "242T00000X",
            "taxonomy_group": "",
            "desc": "Perfusionist",
            "state": "TX",
            "license": "FPF02000199",
            "primary": false
        },
        {
            "code": "242T00000X",
            "taxonomy_group": "",
            "desc": "Perfusionist",
            "state": "PA",
            "license": "PRF000451",
            "primary": false
        },
        {
            "code": "242T00000X",
            "taxonomy_group": "",
            "desc": "Perfusionist",
            "state": "MO",
            "license": "2019027175",
            "primary": false
        },
        {
            "code": "242T00000X",
            "taxonomy_group": "",
            "desc": "Perfusionist",
            "state": "IL",
            "license": "214000415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.srfax.com/sign-in/",
            "affiliation": "N",
            "endpointDescription": "Fax",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Secure Correspondence",
            "address_1": "959 S Indiana Ave",
            "city": "Sellersburg",
            "state": "IN",
            "country_code": "US",
            "postal_code": "471721639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Perfusionist in Sellersburg, IN
• Providers in Sellersburg, IN by specialty
• Perfusionist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; 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.