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IMDAD ULLAH M.D.
NPI 1245646793
Student in an Organized Health Care Education/Training Program in Charleston, WV

Active since July 04, 2014PECOS Enrolled
3110 MACCORKLE AVE SE, CHARLESTON, WV 25304(304) 388-2525(304) 388-2537 Get Directions Write a Review

NPPES record last updated: July 4, 2014. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Imdad Ullah M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IMDAD ULLAH M.D. (NPI 1245646793) is an individual student in an organized health care education/training program in Charleston, West Virginia and active in the NPI registry since July 2014. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1245646793
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameIMDAD ULLAHCredential: M.D.
Location Address3110 MACCORKLE AVE SECharleston, WV 25304-1210
Mailing Address3110 Maccorkle Ave SeCharleston, WV 25304-1210 · (304) 388-2525 · Fax (304) 388-2537
Phone(304) 388-2525
Fax(304) 388-2537
Sole ProprietorNo
Enumeration DateJuly 4, 2014
✔ NPI 1245646793 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
3110 MACCORKLE AVE SE, Charleston, WV 25304
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Imdad Ullah M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Imdad Ullah reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

University Of Illinois Speech And Hearing
376 mi
Speech-Language Pathologist
2001 S OAK ST, SUITE B
Champaign, IL 61820
  • Reassigned Medicare billing, Illinois enrollment
  • Medicare enrollment name: The Board Of Trustees Of The University Of Illinois
  • 2,127 clinicians in this Medicare group
NPI 1497923767 (217) 333-2205

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KARINNA HOPE ANDREWS D.O.
Obstetrics & Gynecology
3110 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 388-2068
TERESA GAYLE WAUGH RN, CDE
Registered Nurse (Diabetes Educator)
3110 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 388-5555
ADAM THOMAS CRAWFORD D.O.
Emergency Medicine
3110 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 388-7170
BRITTAIN MCJUNKIN MD
Internal Medicine (Gastroenterology)
3110 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 347-1300
DR. EMILY A.P. MONTGOMERY M.D.
Obstetrics & Gynecology
3110 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 347-1300
DR. ROBERT MYLES AUSTIN D.O.
Emergency Medicine
3110 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 388-7170
MOHAMED ABDELFATTAH AHMED ARAFA M.D
Student in an Organized Health Care Education/Training Program
3110 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 388-1000
AMOS MART LANE D.O.
Emergency Medicine
3110 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 388-7170

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Imdad Ullah's NPI number?

The NPI number for Imdad Ullah is 1245646793. It was assigned to this individual provider in the NPPES registry on July 4, 2014.

Where is Imdad Ullah located?

Imdad Ullah practices at 3110 Maccorkle Ave SE, Charleston, WV 25304. The listed phone number is (304) 388-2525.

What is Imdad Ullah's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Imdad Ullah enrolled in Medicare?

Yes. Imdad Ullah is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Imdad Ullah's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Imdad Ullah reassigns Medicare benefits to University Of Illinois Speech And Hearing (Champaign, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Imdad Ullah's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Imdad Ullah was last updated on July 4, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.