NPIMap

Organization Active NPI

Trumbull Mahoning Medical Group, Inc.

  • Internal Medicine Physician
  • Cortland, OH
National Provider Identifier
1205020104
Registry record updated Jan 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
TRUMBULL MAHONING MEDICAL GROUP, INC.
Practice address
2600 Elm Rd NE
Cortland, OH 44410-9393
Phone
(330) 372-8800
Fax
(330) 372-8999
NPI assigned
Sep 4, 2007
Organization subpart
Yes
Parent organization
TRUMBULL MAHONING MEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2014

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

Authorized official

Name
Dr. Mourad Rostom, M.D.
Title
Partner/Executive
Phone
(330) 372-8820

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2600 Elm Rd NE
Cortland, OH 44410-9393

Mailing address

2600 Elm Rd NE
Cortland, OH 44410-9393
Phone (330) 372-8800

Other identifiers 3

IdentifierTypeStateIssuer
0468677MedicaidOH
1426141OtherOHHIGHMARK BC/BS PA
000000243183OtherOHANTHEM BC/BS OHIO

Other names 1

  • TMMG Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050309000599 OH Part B Supplier - Clinic/Group Practice 3779537022 Receives reassigned benefits from 7 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cortland, OH; Youngstown, OH

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Trumbull Mahoning Medical Group Inc4 organizations share this tax ID, including this one
Part of
Trumbull Mahoning Medical Group Inc

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389916800000",
    "number": "1205020104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 ELM RD NE",
            "city": "CORTLAND",
            "state": "OH",
            "postal_code": "444109393",
            "telephone_number": "330-372-8800",
            "fax_number": "330-372-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 ELM RD NE",
            "city": "CORTLAND",
            "state": "OH",
            "postal_code": "444109393",
            "telephone_number": "330-372-8800",
            "fax_number": "330-372-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRUMBULL MAHONING MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRUMBULL MAHONING MEDICAL GROUP, INC.",
        "enumeration_date": "2007-09-04",
        "last_updated": "2014-01-17",
        "status": "A",
        "authorized_official_last_name": "ROSTOM",
        "authorized_official_first_name": "MOURAD",
        "authorized_official_title_or_position": "PARTNER/EXECUTIVE",
        "authorized_official_telephone_number": "330-372-8820",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0468677",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BC/BS PA",
            "identifier": "1426141",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS OHIO",
            "identifier": "000000243183",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TMMG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cortland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.