NPIMap

Individual provider Active NPI

Ahmed Salem Mohamed, MD

  • Specialist
  • Mount Vernon, IL
National Provider Identifier
1053633461
Registry record updated Dec 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
036136254 Issued in IL
Practice address
412 S 34TH St Ste 101
Mount Vernon, IL 62864-6021
Phone
(618) 231-6121
Fax
(618) 615-4380
NPI assigned
Feb 26, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 036136254 IL Primary

Addresses

Primary practice location

412 S 34TH St Ste 101
Mount Vernon, IL 62864-6021

Mailing address

412 S 34TH St Ste 101
Mount Vernon, IL 62864-6021
Phone (618) 231-6121

Other practice location 1

741 Insight Ave
O Fallon, IL 62269-2193
Phone (618) 231-6121

Other practice location 2

10012 Manchester Rd
Saint Louis, MO 63122-1826
Phone (314) 948-8414

Other identifiers 1

IdentifierTypeStateIssuer
036136254MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address asalem@egyptianspine.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150122001045 IL Practitioner - Orthopedic Surgery 4284805755 Practice locations: Mount Vernon, IL
O20190702002905 IL DME Supplier - Physician - Orthopedic/Orthopedic Surgery 9537493051 Practice locations: Mount Vernon, IL

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

1104 W Main St
Benton, IL 62812-1565
Phone (618) 439-3399

412 S 34TH St
Suite 101
Mount Vernon, IL 62864-6021
Phone (618) 231-6121

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
21.26 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
70.86

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion221
Laminectomy or laminotomy (partial removal of spine bones)73

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Egyptian Spine Clinic Single Specialty CurrentSince Oct 27, 2015 Accepting new patients
Prairie Spine and Pain Institute SC Single Specialty Past Accepting new patients

Locations

412 S 34th St
Ste 101
Mount Vernon, IL 62864
Phone (443) 509-3678

Interoperability endpoints

  • Direct secure messaging: amoham10@yourcarecommunity.org

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.

Hospital & facility affiliations 12

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": "1267142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670716800000",
    "number": "1053633461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 S 34TH ST STE 101",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646021",
            "telephone_number": "618-231-6121",
            "fax_number": "618-615-4380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 S 34TH ST STE 101",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646021",
            "telephone_number": "618-231-6121",
            "fax_number": "618-615-4380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "741 Insight Ave",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "IL",
            "postal_code": "622692193",
            "country_code": "US",
            "telephone_number": "618-231-6121",
            "fax_number": "618-615-4380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10012 Manchester Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631221826",
            "country_code": "US",
            "telephone_number": "314-948-8414",
            "fax_number": "618-615-4380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOHAMED",
        "first_name": "AHMED",
        "middle_name": "SALEM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-02-26",
        "last_updated": "2022-12-11",
        "certification_date": "2022-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036136254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036136254",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "asalem@egyptianspine.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "412 S 34th St Ste 101",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628646021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

Verify at the official NPI Registry.