NPIMap

Individual provider Active NPI

Alexander David Ghannam, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Toledo, OH
National Provider Identifier
1043715501
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
35.149681 Issued in OH
Practice address
2109 Hughes Dr # 720
Toledo, OH 43606-3858
Phone
(419) 291-2077
Fax
(419) 291-2122
NPI assigned
Mar 27, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X TRN26700 FL
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 35.149681 OH Primary

Addresses

Primary practice location

2109 Hughes Dr # 720
Toledo, OH 43606-3858

Mailing address

100 Madison Ave
Toledo, OH 43604-1516

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20240328003349 OH Practitioner - Cardiac Surgery 9234489139 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac Surgery
Education
Central Michigan College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

2109 Hughes Dr
Suite 760
Toledo, OH 43606-5111
Phone (419) 291-7555

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)51

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TRN26700FLMDSurgery Physician
35.149681OHMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Mar 13, 2024 Accepting new patients
Promedica Central Physicians Surgery CurrentSince Mar 13, 2024 Accepting new patients
The Toledo Hospital Past Accepting new patients

Locations

2109 Hughes Dr
#720
Toledo, OH 43606
Phone (419) 291-2077

2109 Hughes Dr
Ste 760
Toledo, OH 43606
Phone (419) 291-7555

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

2109 Hughes Dr
Ste 720
Toledo, OH 43606
Phone (419) 291-2077

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

Interoperability endpoints

  • Direct secure messaging: aghannam335230@direct.shands.ufl.edu
  • Direct secure messaging: aghannam309724@direct.promedica.org

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 and National Provider Directory roles.

Hospital & facility affiliations 11

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": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1043715501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MADISON AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 HUGHES DR # 720",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063858",
            "telephone_number": "419-291-2077",
            "fax_number": "419-291-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHANNAM",
        "first_name": "ALEXANDER",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-27",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "TRN26700",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "OH",
            "license": "35.149681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.