Individual provider Active NPI

Mohamed B Fouda, MD

  • Internal Medicine Physician
  • Omaha, NE
National Provider Identifier
1104302934
Registry record updated Jul 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
8143 Issued in NE
Practice address
7710 Mercy Rd Ste 202
Omaha, NE 68124-2353
Phone
(402) 280-4392
NPI assigned
Jul 15, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 8143 NE Primary

Addresses

Primary practice location

7710 Mercy Rd Ste 202
Omaha, NE 68124-2353

Mailing address

7710 Mercy Rd Ste 202
Omaha, NE 68124-2353
Phone (402) 280-4392

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20210708001794 FL Practitioner - Internal Medicine 0547513632 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8143NEMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc CurrentSince Jul 19, 2021 Accepting new patients
St Vincents Ambulatory Care Inc Internal Medicine CurrentSince Jul 19, 2021 Accepting new patients

Locations

6699 Gate Pkwy
Ste B
Jacksonville, FL 32256
Phone (904) 450-8140

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

Interoperability endpoints

  • Direct secure messaging: fouda.mohammed.1@15649.direct.athenahealth.com

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": "1531612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531612800000",
    "number": "1104302934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7710 MERCY RD STE 202",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242353",
            "telephone_number": "402-280-4392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7710 MERCY RD STE 202",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242353",
            "telephone_number": "402-280-4392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUDA",
        "first_name": "MOHAMED",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-15",
        "last_updated": "2018-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "8143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.