Individual provider Active NPI

Mohamed Ahmed Soltan, MD

  • Pediatric Urology Physician
  • Memphis, TN
National Provider Identifier
1215653282
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
License
MD00000701000 Issued in TN
Practice address
51 N Dunlap St Ste 100
Memphis, TN 38105-4626
Phone
(901) 663-4801
NPI assigned
Oct 12, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Urology Physician 2088P0231X MD00000701000 TN Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

51 N Dunlap St Ste 100
Memphis, TN 38105-4626

Mailing address

51 N Dunlap St Ste 100
Memphis, TN 38105-4626
Phone (901) 663-4801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241210003279 TN Practitioner - Pediatric MedicinePractitioner - Urology 1951837244 Reassigns benefits to 1 organization
I20241230000047 TN Practitioner - Urology 1951837244 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Urology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut Lebonheur Pediatric Specialists, Inc.Group PAC ID 7719173939, 162 clinicians

Practice addresses (Care Compare)

51 N Dunlap St
Memphis, TN 38105-4625
Phone (901) 287-7337

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00000701000TNMDPediatric Urology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Lebonheur Pediatric Specialists, Inc. CurrentSince Nov 1, 2024 Accepting new patients
St Jude Children'S Research Hospital, Inc. CurrentSince Nov 11, 2024 Accepting new patients

Locations

848 Adams Ave
Memphis, TN 38103
Phone (901) 287-5437

262 Danny Thomas Pl
#515
Memphis, TN 38105
Phone (901) 495-3006

262 Danny Thomas Pl
Memphis, TN 38105
Phone (888) 226-4343

51 N Dunlap St
Ste 100
Memphis, TN 38105
Phone (323) 783-1737

100 N Humphreys Blvd
Memphis, TN 38120
Phone (901) 747-1800

850 Poplar Ave
Bldg 2
Memphis, TN 38105
Phone (901) 287-5594

Interoperability endpoints

  • Direct secure messaging: msoltan30986@mlh.direct-ci.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1215653282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 N DUNLAP ST STE 100",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381054626",
            "telephone_number": "901-663-4801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N DUNLAP ST STE 100",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381054626",
            "telephone_number": "901-663-4801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLTAN",
        "first_name": "MOHAMED",
        "middle_name": "AHMED",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-12",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "TN",
            "license": "MD00000701000",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.