Individual provider Active NPI

Mohammad I Hussain, MD

  • Pediatrics Physician
  • Evansville, IN
National Provider Identifier
1003883265
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01030793A Issued in IN
Practice address
801 St Marys Dr
Suite 203 E
Evansville, IN 47714
Phone
(812) 479-8566
NPI assigned
Mar 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology Physician 2080P0207X 01030793 IN
Pediatrics Physician 208000000X 01030793A IN Primary

Addresses

Primary practice location

801 St Marys Dr
Suite 203 E
Evansville, IN 47714

Mailing address

801 St Marys Dr
Suite 203 E
Evansville, IN 47714
Phone (812) 479-8566

Other practice location 1

3801 Bellemeade Ave Ste 200E
Evansville, IN 47714-0114
Phone (812) 485-7240

Other identifiers 1

IdentifierTypeStateIssuer
100246530MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240621003692 IN Practitioner - Pediatric Medicine 2860792694 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01030793INMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary'S Medical Group, LLC Pediatrics CurrentSince Aug 4, 2024 Accepting new patients
St Mary'S Medical Group, LLC CurrentSince Aug 4, 2024 Accepting new patients

Locations

3801 Bellemeade Ave
Ste 200E
Evansville, IN 47714
Phone (812) 485-1720

801 Saint Marys Dr
Ste 505E
Evansville, IN 47714
Phone (812) 491-3236

250 W 96th St
#520
Indianapolis, IN 46260
Phone (317) 583-3331

100 St Marys Epworth Xing
Ste A100
Newburgh, IN 47630
Phone (812) 469-8160

Interoperability endpoints

  • Direct secure messaging: mohammad.hussain.1@7598.direct.athenahealth.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1003883265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 ST MARYS DR",
            "address_2": "SUITE 203 E",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "47714",
            "telephone_number": "812-479-8566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 ST MARYS DR",
            "address_2": "SUITE 203 E",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "47714",
            "telephone_number": "812-479-8566"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3801 Bellemeade Ave Ste 200E",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477140114",
            "country_code": "US",
            "telephone_number": "812-485-7240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUSSAIN",
        "first_name": "MOHAMMAD",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-07",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "IN",
            "license": "01030793",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01030793A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100246530",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.