NPIMap

Individual provider Active NPI

Bassam Mushannen, MD

  • Cardiovascular Disease Physician
  • Tuscaloosa, AL
National Provider Identifier
1013974179
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
20823 Issued in AL
Practice address
1060 Fairfax Park
Ste B
Tuscaloosa, AL 35406
Phone
(205) 758-6471
Fax
(205) 758-6472
NPI assigned
May 1, 2006
Last updated
Jun 9, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20823 AL
Cardiovascular Disease Physician 207RC0000X 20823 AL Primary

Addresses

Primary practice location

1060 Fairfax Park
Ste B
Tuscaloosa, AL 35406

Mailing address

2760 Lake Crest Dr
Tuscaloosa, AL 35406
Phone (205) 752-9117

Other identifiers 2

IdentifierTypeStateIssuer
000075557MedicaidAL
51075557OtherALBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
20823ALMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hale County Hospital Past Accepting new patients
Hale County Hospital Past Accepting new patients
Southern Surgical Associates LLC Past Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212969600000",
    "number": "1013974179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2760 LAKE CREST DR",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "35406",
            "telephone_number": "205-752-9117",
            "fax_number": "205-758-6472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 FAIRFAX PARK",
            "address_2": "STE B",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "35406",
            "telephone_number": "205-758-6471",
            "fax_number": "205-758-6472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSHANNEN",
        "first_name": "BASSAM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2008-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "20823",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AL",
            "license": "20823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000075557",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51075557",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; 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.