Individual provider Active NPI

Mariam D Oweis, PA-C

  • Surgical Physician Assistant
  • Moorestown, NJ
National Provider Identifier
1164907507
Registry record updated Oct 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
25MP00496400 Issued in NJ
Practice address
401 Young Ave Ste 245
Moorestown, NJ 08057-3132
Phone
(609) 267-9400
Fax
(609) 267-9457
NPI assigned
Oct 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 25MP00496400 NJ Primary

Addresses

Primary practice location

401 Young Ave Ste 245
Moorestown, NJ 08057-3132

Mailing address

4 Eves Dr Ste A100
Marlton, NJ 08053-3126
Phone (609) 267-9400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230911004015 VA Practitioner - Physician Assistant 8921343120 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Practice addresses (Care Compare)

11958 W Broad St
Henrico, VA 23233-1007
Phone (804) 364-6641

1200 E Marshall St
Richmond, VA 23298-5023
Phone (804) 828-9000

401 N 11TH St
Richmond, VA 23219-1914
Phone (804) 828-8737

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-10302NCMDPhysician Assistant
25MP00496400NJMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Urgent Specialty Associates PLLC Past Accepting new patients

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 2

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": "1538438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538438400000",
    "number": "1164907507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 EVES DR STE A100",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533126",
            "telephone_number": "609-267-9400",
            "fax_number": "609-267-9457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 YOUNG AVE STE 245",
            "city": "MOORESTOWN",
            "state": "NJ",
            "postal_code": "080573132",
            "telephone_number": "609-267-9400",
            "fax_number": "609-267-9457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWEIS",
        "first_name": "MARIAM",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-02",
        "last_updated": "2018-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00496400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorestown, NJ

Sources for this page

Verify at the official NPI Registry.