Individual provider Active NPI

Muhanad Ahmed Omran Bensaleem, MD,

  • Pediatrics Physician
  • Festus, MO
National Provider Identifier
1043848559
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2024025980 Issued in MO
Practice address
1390 US Highway 61 Ste 2200N
Festus, MO 63028-4121
Phone
(314) 467-3800
NPI assigned
Mar 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2024025980 MO Primary

Addresses

Primary practice location

1390 US Highway 61 Ste 2200N
Festus, MO 63028-4121

Mailing address

PO Box 776084
Chicago, IL 60677-7939
Phone (314) 467-3800

Other practice location 1

1650 Grand Concourse
Bronx, NY 10457-7606
Phone (718) 590-1800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20240805001439 MO Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 4385181676

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2024025980MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospitals East Communities PastSince Aug 4, 2024 Accepting new patients
Mercy Clinic East Communities Pediatrics PastSince Aug 4, 2024 Accepting new patients

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": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1043848559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606777939",
            "telephone_number": "314-467-3800",
            "fax_number": "636-933-8750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1390 US HIGHWAY 61 STE 2200N",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284121",
            "telephone_number": "314-467-3800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104577606",
            "country_code": "US",
            "telephone_number": "718-590-1800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENSALEEM",
        "first_name": "MUHANAD AHMED OMRAN",
        "credential": "MD,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-30",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2024025980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Festus, MO

Sources for this page

Verify at the official NPI Registry.