Individual provider Active NPI

Mostafa Gamal Hussien Ab Elrazzaz

  • Internal Medicine Physician
  • Danville, VA
National Provider Identifier
1063155968
Registry record updated Oct 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101284055 Issued in VA
Practice address
142 S Main St
Danville, VA 24541-2922
Phone
(434) 799-2225
NPI assigned
Apr 18, 2022
Last updated
Oct 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 0101284055 VA Primary

Addresses

Primary practice location

142 S Main St
Danville, VA 24541-2922

Mailing address

1140 Premier Key Dr
Cary, NC 27513-5372
Phone (502) 389-8568

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
I20250121002604 VA Practitioner - Internal Medicine 7416486469 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ingleside Physician Services, LLCGroup PAC ID 6103174255, 12 clinicians
Apogee Medical Group Virginia PCGroup PAC ID 0345310256, 34 clinicians

Practice addresses (Care Compare)

1 Arh Lane
Low Moor, VA 24457
Phone (540) 862-6011

142 S Main St
Danville, VA 24541-2922
Phone (434) 799-2225

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101284055VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Apogee Medical Group Virginia, PC Internal Medicine CurrentSince Nov 1, 2024 Accepting new patients
Ingleside Physician Services, LLC CurrentSince Dec 27, 2025 Accepting new patients

Locations

142 S Main St
Danville, VA 24541
Phone (434) 799-2100

1 Arh Ln
Low Moor, VA 24457
Phone (540) 345-2593

320 Hospital Dr
Martinsville, VA 24112
Phone (276) 666-7200

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1650240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759708800000",
    "number": "1063155968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 PREMIER KEY DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275135372",
            "telephone_number": "502-389-8568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 S MAIN ST",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245412922",
            "telephone_number": "434-799-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELRAZZAZ",
        "first_name": "MOSTAFA",
        "middle_name": "GAMAL HUSSIEN AB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-18",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101284055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, VA

Sources for this page

Verify at the official NPI Registry.