NPIMap

Individual provider Active NPI

Elmoutaz Tawfig Mousa, M.D.

  • Nephrology Physician
  • Lubbock, TX
National Provider Identifier
1124287735
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
Q4474 Issued in TX
Practice address
3708 22ND PL Unit 1
Lubbock, TX 79410-1353
Phone
(806) 771-7412
Fax
(806) 771-7414
NPI assigned
Jun 9, 2008
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Q4474 TX Primary
Internal Medicine Physician 207R00000X Q4474 TX

Addresses

Primary practice location

3708 22ND PL Unit 1
Lubbock, TX 79410-1353

Mailing address

PO Box 54136
Lubbock, TX 79453-4136
Phone (806) 771-1386

Other names 1

  • Elmoutaz Mousa Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20170722000197 TX Practitioner - NephrologyPractitioner - Internal Medicine 4486822640 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hospitalist Medicine Physicians of Texas PLLCGroup PAC ID 3476688318, 685 clinicians
Lubbock Nephrology Associates, P.a.Group PAC ID 6406936525, 4 clinicians

Practice addresses (Care Compare)

3615 19TH St
Lubbock, TX 79410-1203
Phone (806) 725-0000

3708 22ND PL
Unit 1
Lubbock, TX 79410-1353
Phone (806) 771-7412

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hub City Surgery Center, LLC CurrentSince Jul 5, 2024 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince Mar 1, 2025 Accepting new patients
Lubbock Nephrology Associates, P.a. Internal Medicine CurrentSince Aug 1, 2017 Accepting new patients
Fresenius Medical Care Lamesa, LLC PastSince Mar 2, 2018 Accepting new patients
Angelo Kidney Connection, PLLC Past Accepting new patients

Locations

18951 N Memorial Dr
Humble, TX 77338
Phone (281) 319-8409

2232 Indiana Ave
Ste 1
Lubbock, TX 79410
Phone (806) 395-4705

3615 19th St
Lubbock, TX 79410
Phone (806) 725-0000

3708 22nd Pl
Unit 1
Lubbock, TX 79410
Phone (806) 771-7412

3180 Executive Dr
Ste 102
San Angelo, TX 76904
Phone (325) 944-1240

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

Interoperability endpoints

  • Direct secure messaging: elmoutaz.mousa.p161@direct.lifelinevascular.nextgenshare.com
  • Direct secure messaging: elmoutaz.mousa@direct.myteamcare.com
  • Direct secure messaging: elmoutazmousa@lubbockneph.allscriptsdirect.net

Organizations & group practices 5

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 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1124287735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54136",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794534136",
            "telephone_number": "806-771-1386",
            "fax_number": "806-771-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3708 22ND PL UNIT 1",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101353",
            "telephone_number": "806-771-7412",
            "fax_number": "806-771-7414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUSA",
        "first_name": "ELMOUTAZ",
        "middle_name": "TAWFIG",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "Q4474",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "Q4474",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELMOUTAZ",
            "last_name": "MOUSA",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.