Individual provider Active NPI

Obadah Ezzeldin, MD

  • Vascular & Interventional Radiology Physician
  • Galveston, TX
National Provider Identifier
1245724343
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
U4799 Issued in TX
Practice address
301 University Blvd
Galveston, TX 77555
Phone
(409) 747-2849
Fax
(409) 772-7120
NPI assigned
Jun 21, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X U4799 TX
Vascular & Interventional Radiology Physician 2085R0204X U4799 TX Primary

Addresses

Primary practice location

301 University Blvd
Galveston, TX 77555

Mailing address

PO Box 650859
Dept 710
Dallas, TX 75265-0859
Phone (409) 266-0175

Other practice location 1

301 University Blvd
Galveston, TX 77555
Phone (409) 747-2849

Other practice location 2

4646 N Marine Dr
Chicago, IL 60640-5759
Phone (773) 564-5235

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20240201004009 TX Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 2668722240 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utmb Faculty Group PracticeGroup PAC ID 3375456734, 1,083 clinicians

Practice addresses (Care Compare)

301 University Blvd
Galveston, TX 77555-5302
Phone (409) 772-2222

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.88 of 100Reported as group
Quality
73.38
Improvement activities
40
Cost
78.42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
U4799TXMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Utmb Faculty Group Practice Internal Medicine CurrentSince Feb 9, 2024 Accepting new patients

Locations

2020 E Highway 6
Alvin, TX 77511
Phone (281) 585-2530

301 University Blvd
Galveston, TX 77555
Phone (409) 747-1883

511 Park Grove Dr
Katy, TX 77450
Phone (281) 398-7001

200 Blossom St
Webster, TX 77598
Phone (281) 252-7000

Interoperability endpoints

  • Direct secure messaging: oezzeldin44341@direct.utmb.edu

Organizations & group practices 1

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 1

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": "1529539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1245724343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650859",
            "address_2": "DEPT 710",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752650859",
            "telephone_number": "409-266-0175",
            "fax_number": "409-772-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 UNIVERSITY BLVD",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "77555",
            "telephone_number": "409-747-2849",
            "fax_number": "409-772-7120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 University Blvd",
            "address_purpose": "LOCATION",
            "city": "Galveston",
            "state": "TX",
            "postal_code": "77555",
            "country_code": "US",
            "telephone_number": "409-747-2849",
            "fax_number": "409-772-7120",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4646 N Marine Dr",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606405759",
            "country_code": "US",
            "telephone_number": "773-564-5235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EZZELDIN",
        "first_name": "OBADAH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-21",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "U4799",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "TX",
            "license": "U4799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galveston, TX

Sources for this page

Verify at the official NPI Registry.