Michael Abdelmisseh, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

62642 Issued in TN

Practice address

1720 Woodlawn Ave
Dyersburg, TN 38024

Phone

(731) 287-4500

Fax

(731) 287-4585

NPI assigned

May 24, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• WT Medical Associates

  • Internal Medicine Physician
  • Dyersburg, TN
  • NPI 1295223279

  TN

  Medicare reassignment NPD
• WT Medical Associates

  • Rural Health Clinic/Center
  • Halls, TN
  • NPI 1356176556
  NPD
• WT Medical Associates

  • Rural Health Clinic/Center
  • Dyersburg, TN
  • NPI 1427604198
  NPD
• Reedley Community Hospital

  • General Acute Care Hospital
  • Reedley, CA
  • NPI 1336167550
  NPD
• Reedley Community Hospital

  • Rural Health Clinic/Center
  • Earlimart, CA
  • NPI 1821699620
  NPD
• Adventist Health Physicians Network

  • Cardiovascular Disease Physician
  • Los Angeles, CA
  • NPI 1942602883
  NPD (past)

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1225529241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 WOODLAWN AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380241300",
            "telephone_number": "731-287-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 WOODLAWN AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "38024",
            "telephone_number": "731-287-4500",
            "fax_number": "731-287-4585"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9300 Valley Childrens Pl",
            "address_purpose": "LOCATION",
            "city": "Madera",
            "state": "CA",
            "postal_code": "93636",
            "country_code": "US",
            "telephone_number": "559-353-5141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ABDELMISSEH",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-24",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "62642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• A-1 Transportation,LLC
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• Air Evac EMS Inc.
• Wyatt Robert Algee, M.D.
• Jared Michael Alvey, OT

• All providers in Dyersburg, TN
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.