Active NPI
Moustafa Moussally
- General Practice Physician
- Cleveland, OH
National Provider Identifier
1104434620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 57.249624
- Practice address
- 9500 Euclid Ave
Cleveland, OH 44195-0001 - Phone
- (216) 444-2200
- NPI assigned
- Jul 21, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 57.249624 | OH | Primary |
Addresses
Primary practice location
9500 Euclid Ave
Cleveland, OH 44195-0001
Mailing address
2495 Interlachen LN
Westlake, OH 44145-4381
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201201000289 | OH | Order and Referring Only - General Surgery | 5092126805 |
Care Compare profile
Medicare Care Compare- Specialty
- Colorectal Surgery (Proctology)
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
8055 Mayfield Rd
Chesterland, OH 44026-2447
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595289600000",
"number": "1104434620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2495 INTERLACHEN LN",
"city": "WESTLAKE",
"state": "OH",
"postal_code": "441454381"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9500 EUCLID AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441950001",
"telephone_number": "216-444-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUSSALLY",
"first_name": "MOUSTAFA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-21",
"last_updated": "2020-07-21",
"certification_date": "2020-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "OH",
"license": "57.249624",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.