Elmoutaz Tawfig Mousa, M.D.
Individual provider Active NPI Nephrology Physician · Lubbock, TX
NPI 1124287735 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1124287735
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- Q4474 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 15
Medicare Care Compare profile
- Specialty
- Nephrology
- 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 PLLC
Lubbock Nephrology Associates, P.a.
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
- Angelo Kidney Connection
- Lubbock Dialysis Center-Redbud
- Kidney Care Center Lubbock
- FKC Caprock
- Fresenius Medical Care Lubbock
- Covenant Medical Center
- University Medical Center
- Shannon Medical Center
- Nor-Lea Hospital District
- Memorial Hospital
- South Plains Rehabilitation Hospital an Affiliate
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170722000197 | TX | Practitioner - Nephrology |
4486822640 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospitalist Medicine Physicians of Texas, PLLC | Internal Medicine | Current |
Accepting new patients |
| Hub City Surgery Center, LLC | Current |
Accepting new patients | |
| Lubbock Nephrology Associates, P.a. | Internal Medicine | Current |
Accepting new patients |
| Angelo Kidney Connection, PLLC | Past | Accepting new patients | |
| Fresenius Medical Care Lamesa, LLC | 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
- elmoutaz.mousa@direct.myteamcare.com
- elmoutaz.mousa.p161@direct.lifelinevascular.nextgenshare.com
- elmoutazmousa@lubbockneph.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | Q4474 | TX | Yes |
| 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
- Elmoutaz Mousa
NPI Registry JSON
{
"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
- Jaime Mothershed
- Madison Renay Motley
- Bradley Adam Mott
- Melissa Lynn Mott
- Jennifer Mounce
- Sara Mousa
- Tyler Mouw
- Mia Mowzoon
- Annie Lin Moy
- Adrianna Gregoria Moya
All providers in Lubbock, TX · Nephrology Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.