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MAHMOUD MAHFOUZ MD
NPI 1356893465
Internal Medicine - Gastroenterology in Miami, FL

Active since October 25, 2016PECOS EnrolledAccepts Medicare Assignment
81.31/100
CMS Quality Rating
1611 NW 12TH AVE, MIAMI, FL 33136(305) 585-5215 Get Directions Write a Review

NPPES record last updated: January 24, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 10, 2023, Mar 7, 2023, May 19, 2022 and 4 more (7 updates tracked since 2016).

About Mahmoud Mahfouz Md NPPES

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

MAHMOUD MAHFOUZ MD (NPI 1356893465) is an individual gastroenterology provider in Miami, Florida, licensed in Florida (ME137405) and active in the NPI registry since October 2016. He is enrolled in Medicare PECOS, is affiliated with Jackson Health System, and maintains a secondary practice location in Miami.

NPPES Registry Identity

NPI1356893465
Entity TypeIndividualMale
Primary Taxonomy207RG0100X
Provider Legal NameMAHMOUD MAHFOUZCredential: MD
Location Address1611 NW 12TH AVEMiami, FL 33136-1005
Mailing Address1611 Nw 12th AveMiami, FL 33136-1005 · (305) 585-5215
Phone(305) 585-5215
Sole ProprietorNo
Medical School CMSOtherGraduated 2015
Enumeration DateOctober 25, 2016
Last NPPES UpdateJanuary 24, 20247 updates tracked since enumeration
NPPES CertifiedJanuary 24, 2024
✔ NPI 1356893465 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code207RG0100X
License✔ Licensed in FL · ME137405
Definition
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.
1611 NW 12TH AVE, Miami, FL 33136
Open in Google Maps ↗

Secondary Practice Location 1

Location 11400 NW 12th AveMiami, FL 33136-1003 · Phone (305) 689-5413 · Fax (305) 243-3762

Other Identifiers 1

OtherME137405FL · License Number

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter of Alabama, AmeriHealth Caritas Next and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mahmoud Mahfouz Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2668725094
PECOS Enrollment IDI20220606000872
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 Reassignments

2

Medicare enrollment records show Mahmoud Mahfouz reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

University Of Miami
Same address
Pulmonary Disease
1611 NW 12TH AVE, BOX 016960 M851
Miami, FL 33136
  • Reassigned Medicare billing, Florida enrollment
  • 3,639 clinicians in this Medicare group
NPI 1003866617 (305) 243-7688
Mayo Clinic Jacksonville
317 mi
Health Service
4500 SAN PABLO RD S
Jacksonville, FL 32224
  • Reassigned Medicare billing, Florida enrollment
  • 1,828 clinicians in this Medicare group
NPI 1174143986 (904) 953-2000

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

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
52 services40 patients
Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239
This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.
31 services29 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
25 services23 patients
Biopsy of large bowel using a flexible endoscope 45380
A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.
16 services16 patients
Review by radiologist of image from tube placement into bile duct using an endoscope 74328
This procedure involves a specialist, called a radiologist, examining an image taken during a tube placement into your bile duct. The tube is inserted with the help of a tool called an endoscope. This allows the doctor to check for any issues or abnormalities in your bile duct.
14 services11 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
13 services13 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Jackson Health System

Acute Care Hospitals · Miami, FL
1/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number100022
Location1611 NW 12th AveMiami, FL 33136 · Miami-Dade County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33136 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$141.56 typical visit price
range $60.92 – $187.05
Typical copayment $35.39 (range $15.23 – $46.76)
Most-billed visit code 99204
Established Patient
$107.17 typical visit price
range $18.99 – $150.24
Typical copayment $26.79 (range $4.74 – $37.56)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

81.31/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality78.45
Promoting Interoperability100
Improvement Activities40
Cost50.59

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. AKUA GYANEWAH ASARE MD
Student in an Organized Health Care Education/Training Program
1611 NW 12TH AVE
MIAMI, FL 33136
Miami-Dade County (305) 355-8264
MARILUZ SANCHEZ PHARM.D.
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
1611 NW 12TH AVE, PHARMACY ADM. OFFICES/EAST TOWER BASEMENT 069
MIAMI, FL 33136
Miami-Dade County (305) 585-7309
DR. TASHA JOYTI N. D. COOKE TASHA COOKE
Student in an Organized Health Care Education/Training Program
1611 NW 12TH AVE
MIAMI, FL 33136
Miami-Dade County (305) 243-3670
DR. JUANITA ANN MARIE HUNTER M.D.
Pediatrics (Pediatric Cardiology)
1611 NW 12TH AVE
MIAMI, FL 33136
Miami-Dade County (305) 585-6042
WANDA LAVERNE MCGOWAN-BRAYNEN ARNP
Nurse Practitioner (Adult Health)
1611 NW 12TH AVE
MIAMI, FL 33136
Miami-Dade County (305) 585-1111
DR. PERTTI KALEVI HAKALA M.D.
Anesthesiology
1611 NW 12TH AVE, CENTRAL 300
MIAMI, FL 33136
Miami-Dade County (305) 585-6970
JAYLOU M VELEZ TORRES M.D.
Pathology (Anatomic Pathology)
1611 NW 12TH AVE
MIAMI, FL 33136
Miami-Dade County (305) 585-8381
ANNE-ISABELLE SOPHIA REME MD
Surgery
1611 NW 12TH AVE
MIAMI, FL 33136
Miami-Dade County (305) 585-1280

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 Mahmoud Mahfouz's NPI number?

The NPI number for Mahmoud Mahfouz is 1356893465. It was assigned to this individual provider in the NPPES registry on October 25, 2016.

Where is Mahmoud Mahfouz located?

Mahmoud Mahfouz practices at 1611 NW 12th Ave, Miami, FL 33136. The listed phone number is (305) 585-5215.

What is Mahmoud Mahfouz's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Gastroenterology, with taxonomy code 207RG0100X.

Is Mahmoud Mahfouz enrolled in Medicare?

Yes. Mahmoud Mahfouz is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Mahmoud Mahfouz's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mahmoud Mahfouz reassigns Medicare benefits to 2 organizations: University Of Miami (Miami, FL) and Mayo Clinic Jacksonville (Jacksonville, FL). Each 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 Mahmoud Mahfouz's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mahmoud Mahfouz accept?

Health plans from Ambetter Health, Ambetter of Alabama, AmeriHealth Caritas Next, Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) and 3 other insurers list Mahmoud Mahfouz as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Mahmoud Mahfouz affiliated with any hospitals?

According to CMS data, Mahmoud Mahfouz is affiliated with Jackson Health System.

When was this NPI record last updated?

The NPPES record for Mahmoud Mahfouz was last updated on January 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.