Individual provider Active NPI

Amin Haroun Al Haj Moussa, MD

  • Student in an Organized Health Care Education/Training Program
  • Houston, TX
National Provider Identifier
1063146793
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
BP10091552 Issued in TX
Practice address
1133 John Freeman Blvd Ste JJL 205N
Houston, TX 77030-2809
Phone
(713) 500-5784
NPI assigned
Jul 9, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 0101284790 VA
Student in an Organized Health Care Education/Training Program 390200000X BP10091552 TX Primary

Addresses

Primary practice location

1133 John Freeman Blvd Ste JJL 205N
Houston, TX 77030-2809

Mailing address

1133 John Freeman Blvd Ste JJL 205N
Houston, TX 77030-2809
Phone (713) 500-5784

Other practice location 1

4348 Electric Rd
Roanoke, VA 24018-0720
Phone (540) 769-0976

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20220809004065 VA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 9032592928

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101284790VAMDPediatrics Physician
BP10091552TXMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1657324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1063146793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 JOHN FREEMAN BLVD STE JJL 205N",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302809",
            "telephone_number": "713-500-5784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 JOHN FREEMAN BLVD STE JJL 205N",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302809",
            "telephone_number": "713-500-5784"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4348 Electric Rd",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240180720",
            "country_code": "US",
            "telephone_number": "540-769-0976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AL HAJ MOUSSA",
        "first_name": "AMIN",
        "middle_name": "HAROUN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-09",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101284790",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "BP10091552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.