Organization Active NPI

Mustapha Bourara MD PC

  • Clinic/Center
  • Astoria, NY
National Provider Identifier
1114161932
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MUSTAPHA BOURARA MD PC
Practice address
3047 38TH St
Astoria, NY 11103-3831
Phone
(718) 777-7577
Fax
(718) 777-7055
NPI assigned
Apr 23, 2009
Last updated
Feb 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

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

Authorized official

Name
Mustapha Bourara, M.D.NPI 1437112083
Title
Physician
Phone
(718) 777-7577

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

3047 38TH St
Astoria, NY 11103-3831

Mailing address

3047 38TH St
Astoria, NY 11103-3831
Phone (718) 777-7577

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090529000245 NY Part B Supplier - Clinic/Group Practice 1153470836 Receives reassigned benefits from 1 practitioner
Practice locations: Astoria, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2318561Mustapha Bourara MD PC3047 38TH Street, Astoria, NY 11103Certificate of waiverFeb 12, 2027

National Provider Directory

National Provider Directory

Locations

6902 Austin St
Fl 3A
Forest Hills, NY 11375
Phone (646) 552-2920

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738886400000",
    "number": "1114161932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3047 38TH ST",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111033831",
            "telephone_number": "718-777-7577",
            "fax_number": "718-777-7055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3047 38TH ST",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111033831",
            "telephone_number": "718-777-7577",
            "fax_number": "718-777-7055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUSTAPHA BOURARA MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-23",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A",
        "authorized_official_last_name": "BOURARA",
        "authorized_official_first_name": "MUSTAPHA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "718-777-7577",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.