NPIMap

Individual provider Active NPI

Nasser A Moukaddem, MD

  • Internal Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1124008883
Registry record updated Dec 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
FLME0071447 Issued in FL
Practice address
4226 Central Ave
St Petersburg, FL 33711-1140
Phone
(727) 321-3915
NPI assigned
Jan 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2013

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 FLME0071447 FL Primary

Addresses

Primary practice location

4226 Central Ave
St Petersburg, FL 33711-1140

Mailing address

4226 Central Ave
St Petersburg, FL 33711-1140
Phone (727) 321-3915

Other identifiers 2

IdentifierTypeStateIssuer
110189691OtherFLRAILROAD MEDICARE
254197100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040721000396 FL Practitioner - Internal Medicine 1658274683 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellmed Medical Management of Florida IncGroup PAC ID 3971678558, 158 clinicians

Practice addresses (Care Compare)

2155 SE Federal Hwy
Wellmed at South Stuart
Stuart, FL 34994-4514
Phone (772) 223-9630

Hospital & facility affiliations

  • Pinnacle Home Care Home health agency, Oldsmar, FL, CCN 108290
  • Baycare Home Care Inc Home health agency, Largo, FL, CCN 107212
  • St Josephs Hospital Hospital, Tampa, FL, CCN 100075
  • Morton Plant Hospital Hospital, Clearwater, FL, CCN 100127
  • St Anthonys Hospital Hospital, Saint Petersburg, FL, CCN 100067
  • HCA Florida Pasadena Hospital a Part of HCA Florid Hospital, Saint Petersburg, FL, CCN 100126
  • HCA Florida St Petersburg Hospital Hospital, Saint Petersburg, FL, CCN 100180

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
FLME0071447FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmed Medical Management of Florida Inc CurrentSince Feb 1, 2022 Accepting new patients
Orlando Health, Inc. Current Accepting new patients
Elias Kanaan MD PA Internal Medicine PastSince Aug 20, 2001 Accepting new patients

Locations

960 58th St N
St Petersburg, FL 33710
Phone (727) 820-7778

4226 Central Ave
St Petersburg, FL 33711
Phone (727) 321-3915

2155 SE Federal Hwy
Stuart, FL 34994
Phone (772) 223-9630

8637 Fredericksburg Rd
Ste 360
San Antonio, TX 78240
Phone (210) 304-3500

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: nasser.moukaddem@wellmed.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/ADDJAA
  • Direct secure messaging: nmoukaddem189003@orlandohealth.medalliesdirect.net

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386115200000",
    "number": "1124008883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4226 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337111140",
            "telephone_number": "727-321-3915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4226 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337111140",
            "telephone_number": "727-321-3915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUKADDEM",
        "first_name": "NASSER",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2013-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "FLME0071447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110189691",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254197100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.