NPIMap

Individual provider Active NPI

Michael Emeel Mousa, M.D.

  • Diagnostic Radiology Physician
  • Fresno, CA
National Provider Identifier
1194025221
Registry record updated Apr 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A136912 Issued in CA
Practice address
228 S Clovis Ave
Fresno, CA 93727-4254
Phone
(714) 801-8878
NPI assigned
Oct 22, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X A136912 CA Primary

Addresses

Primary practice location

228 S Clovis Ave
Fresno, CA 93727-4254

Mailing address

228 S Clovis Ave
Fresno, CA 93727-4254
Phone (714) 801-8878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150724009759 CA Practitioner - Diagnostic Radiology 6608189394 Reassigns benefits to 1 organization
I20180424002663 TX Practitioner - Diagnostic Radiology 6608189394 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Iowa, RJ & L Carver College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

Riverside, CA 92501
Phone (951) 788-3400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS, PHS, Naihs, Shiprock Hospital Current Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Apr 29, 2018 Accepting new patients
DHHS, PHS, Naihs, Gallup Indian Medical Center CurrentSince Apr 24, 2018 Accepting new patients
DHHS,PHS,Naihs, Gallup Indian Medical Center CurrentSince Apr 24, 2018 Accepting new patients
Covalent Radiology Inc a Professional Medical Corporation Diagnostic Radiology Current Accepting new patients
Pco PC Diagnostic Radiology Past Accepting new patients

Locations

6 Road 7586
Bloomfield, NM 87413
Phone (505) 368-8015

516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326

Interoperability endpoints

  • Direct secure messaging: mmousa65477@direct.llu.edu

Organizations & group practices 7

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 5

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": "1287705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461628800000",
    "number": "1194025221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 S CLOVIS AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937274254",
            "telephone_number": "714-801-8878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 S CLOVIS AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937274254",
            "telephone_number": "714-801-8878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUSA",
        "first_name": "MICHAEL",
        "middle_name": "EMEEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-22",
        "last_updated": "2016-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A136912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.