NPIMap

Individual provider Active NPI

Hossam Eldin Imam Mustafa, MD

  • Clinical Cardiac Electrophysiology Physician
  • Saginaw, MI
National Provider Identifier
1215145420
Registry record updated Mar 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
4301086127 Issued in MI
Practice address
900 Cooper Ave Ste 4100
Saginaw, MI 48602
Phone
(989) 583-4700
Fax
(989) 583-7173
NPI assigned
May 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X 35.089607 OH
Clinical Cardiac Electrophysiology Physician 207RC0001X 4301086127 MI Primary

Addresses

Primary practice location

900 Cooper Ave Ste 4100
Saginaw, MI 48602

Mailing address

1447 N Harrison St
Saginaw, MI 48602-4727
Phone (989) 583-4700

Other practice location 1

2409 Cherry St Ste 100
Toledo, OH 43608-2670
Phone (419) 251-3700

Other practice location 2

2409 Cherry St Ste 100
Toledo, OH 43608-2670
Phone (419) 251-3700

Other identifiers 1

IdentifierTypeStateIssuer
2760043MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address hmustafa80316@direct.covenanthealthcare.com
Direct Messaging Address hmustafa80316@direct.covenanthealthcare.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20190814003571 MI Practitioner - Cardiac Electrophysiology 4082708292 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac Electrophysiology
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Covenant Medical Center, Inc.Group PAC ID 2769387778, 488 clinicians

Practice addresses (Care Compare)

900 Cooper Ave
Suite 4100
Saginaw, MI 48602-5182
Phone (989) 583-7175

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair84

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301086127MIMDClinical Cardiac Electrophysiology Physician
35.089607OHMDClinical Cardiac Electrophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Center, Inc. Current Accepting new patients
Covenant Medical Center, Inc CurrentSince Sep 1, 2019 Accepting new patients
Tennessee Heart and Lung Institute PLC Past Accepting new patients
Clarksville Physician Services LLC Past Accepting new patients

Locations

2750 Main St
Ste 3
Marlette, MI 48453
Phone (989) 635-4023

1447 N Harrison St
Saginaw, MI 48602
Phone (989) 583-4220

800 Cooper Ave
Ste 3
Saginaw, MI 48602
Phone (517) 759-0322

900 Cooper Ave
Ste 4100
Saginaw, MI 48602
Phone (989) 497-9395

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1879/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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 9

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": "1179532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1215145420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1447 N HARRISON ST",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486024727",
            "telephone_number": "989-583-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 COOPER AVE STE 4100",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "48602",
            "telephone_number": "989-583-4700",
            "fax_number": "989-583-7173"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2409 Cherry St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436082670",
            "country_code": "US",
            "telephone_number": "419-251-3700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2409 Cherry St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436082670",
            "country_code": "US",
            "telephone_number": "419-251-3700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUSTAFA",
        "first_name": "HOSSAM ELDIN",
        "middle_name": "IMAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-19",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "OH",
            "license": "35.089607",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "MI",
            "license": "4301086127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2760043",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hmustafa80316@direct.covenanthealthcare.com",
            "affiliation": "N",
            "address_1": "900 Cooper Ave Ste 4100",
            "city": "Saginaw",
            "state": "MI",
            "country_code": "US",
            "postal_code": "48602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hmustafa80316@direct.covenanthealthcare.com",
            "affiliation": "N",
            "address_1": "2409 Cherry St Ste 100",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436082670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.