NPIMap

Individual provider Active NPI

Victor Anthony Maalouf, D.O.

  • Emergency Medicine Physician
  • Hannibal, MO
National Provider Identifier
1073543880
Registry record updated Mar 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2015040160 Issued in MO
Practice address
6000 Hospital Dr
Hannibal, MO 63401-6887
Phone
(573) 248-5100
Fax
(573) 248-5112
NPI assigned
Jul 4, 2006
Last updated
Mar 6, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 20A7722 CA
Emergency Medicine Physician 207P00000X 2015040160 MO Primary

Addresses

Primary practice location

6000 Hospital Dr
Hannibal, MO 63401-6887

Mailing address

PO Box 551
Hannibal, MO 63401-0551
Phone (573) 248-5100

Other identifiers 2

IdentifierTypeStateIssuer
00AX77220MedicaidCA
2015040160OtherMOSTATE MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, MO2 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
I20040809001492 CA Practitioner - Emergency Medicine 2163494238 Reassigns benefits to 1 organization
I20151223000582 MO Practitioner - Emergency Medicine 2163494238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
College of Osteo Med of the Pacific at Pomona, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

PO Box
Suite 1257
Hannibal, MO 63401-1257
Phone (573) 248-5460

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1268NEMDOptometrist
20A7722CAMDEmergency Medicine Physician
2015040160MOMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hannibal Regional Healthcare System Inc CurrentSince Sep 15, 2016 Accepting new patients
Glenn Medical Center, LLC CurrentSince May 1, 2015 Accepting new patients
Glenn Medical Center, LLC CurrentSince May 1, 2015 Accepting new patients
Glenn Medical Center, LLC Current Accepting new patients
Orthowest LLC Past Accepting new patients
Melvin a. Ochs, M.D., Medica Corp Emergency Medicine Past Accepting new patients
Glenn Medical Center, LLC Past Accepting new patients
Decatur Emergency Medical Services II S C Past Accepting new patients
Decatur Memorial Hospital Past Accepting new patients
Hannibal Regional Heathcare System, Inc Past Accepting new patients
Hannibal Regional Healthcare System, Inc Past Accepting new patients

Locations

1133 W Sycamore St
Willows, CA 95988
Phone (530) 934-1800

6000 Hospital Dr
Hannibal, MO 63401
Phone (573) 248-5460

6000 Hospital Dr
#1257
Hannibal, MO 63401
Phone (573) 248-5460

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602

Organizations & group practices 11

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 1

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488758400000",
    "number": "1073543880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634010551",
            "telephone_number": "573-248-5100",
            "fax_number": "573-248-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 HOSPITAL DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016887",
            "telephone_number": "573-248-5100",
            "fax_number": "573-248-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAALOUF",
        "first_name": "VICTOR",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2017-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "20A7722",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2015040160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX77220",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "2015040160",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hannibal, MO

Sources for this page

Verify at the official NPI Registry.