NPIMap

Individual provider Active NPI

Eid B Mustafa, MD

  • Plastic and Reconstructive Surgery Physician
  • Wichita Falls, TX
National Provider Identifier
1023018470
Registry record updated May 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
G272 Issued in TX
Practice address
1201 Brook Ave
Wichita Falls, TX 76301-5601
Phone
(940) 322-1122
Fax
(940) 767-8918
NPI assigned
Jul 28, 2005
Reactivated
Apr 3, 2006
Last updated
May 12, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X G272 TX Primary

Addresses

Primary practice location

1201 Brook Ave
Wichita Falls, TX 76301-5601

Mailing address

1201 Brook Ave
Wichita Falls, TX 76301-5601
Phone (940) 322-1122

Other identifiers 2

IdentifierTypeStateIssuer
120179005MedicaidTX
240006708OtherRAILROAD MEDICARE PIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041122000505 TX Practitioner - Plastic and Reconstructive Surgery 1456316207 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1201 Brook Ave
Wichita Falls, TX 76301-5601
Phone (940) 322-1122

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)12
Melanoma (skin cancer) excision344
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy27

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G272TXMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Regional Health Care System Inc Current Accepting new patients
Eid B. Mustafa, MD PA Plastic and Reconstructive Surgery CurrentSince Jun 1, 2004 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

1201 Brook Ave
Wichita Falls, TX 76301
Phone (817) 332-1122

Interoperability endpoints

  • Direct secure messaging: eidmustafa@directaddress.net
  • Direct secure messaging: emustafa14364@unitedregional.medalliesdirect.net
  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/fhir/r4/

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399852800000",
    "number": "1023018470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 BROOK AVE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763015601",
            "telephone_number": "940-322-1122",
            "fax_number": "940-767-8918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 BROOK AVE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763015601",
            "telephone_number": "940-322-1122",
            "fax_number": "940-767-8918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSTAFA",
        "first_name": "EID",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2014-05-12",
        "deactivation_date": "2006-03-22",
        "reactivation_date": "2006-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TX",
            "license": "G272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120179005",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "240006708",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

Verify at the official NPI Registry.