NPIMap

Individual provider Active NPI

Essam A Mostafa, M.D.

  • Nephrology Physician
  • Fountain Valley, CA
National Provider Identifier
1316932270
Registry record updated Sep 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
C55143 Issued in CA
Practice address
11100 Warner Ave Ste 158
Fountain Valley, CA 92708-7510
Phone
(714) 486-2586
Fax
(714) 432-8885
NPI assigned
Sep 16, 2005
Last updated
Sep 16, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X C55143 CA Primary

Addresses

Primary practice location

11100 Warner Ave Ste 158
Fountain Valley, CA 92708-7510

Mailing address

11100 Warner Ave Ste 158
Fountain Valley, CA 92708-7510
Phone (714) 486-2586

Other identifiers 1

IdentifierTypeStateIssuer
C55143MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20120827000560 CA Practitioner - NephrologyPractitioner - Internal Medicine 1052219664 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Nephrology of Orange County IncGroup PAC ID 8820420631, 3 clinicians

Practice addresses (Care Compare)

11100 Warner Ave
Suite 158
Fountain Valley, CA 92708-7510
Phone (714) 486-2586

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Nephrology of Orange County Inc Nephrology CurrentSince Sep 15, 2019 Accepting new patients
Chapman Medical Center Inc Past Accepting new patients
Reid Hospital & Health Care Services, Inc Past Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients
Anaheim Memorial Medical Center Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients
Hoag Memorial Hospital Presbyterian Past Accepting new patients
South Coast Global Medical Center, Inc Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients
Orange County Global Medical Center, Inc Past Accepting new patients

Locations

5832 Beach Blvd
Unit 214
Buena Park, CA 90621
Phone (714) 486-2586

11100 Warner Ave
Ste 158
Fountain Vly, CA 92708
Phone (714) 432-8884

17150 Euclid St
Ste 200
Fountain Vly, CA 92708
Phone (714) 751-0995

12666 Brookhurst St
Ste 130
Garden Grove, CA 92840
Phone (714) 332-1069

17822 Beach Blvd
Ste 430
Huntington Beach, CA 92647
Phone (714) 486-2586

15825 Laguna Canyon Rd
Ste 104
Irvine, CA 92618
Phone (714) 486-2586

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568592000000",
    "number": "1316932270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11100 WARNER AVE STE 158",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927087510",
            "telephone_number": "714-486-2586",
            "fax_number": "714-432-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 WARNER AVE STE 158",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927087510",
            "telephone_number": "714-486-2586",
            "fax_number": "714-432-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSTAFA",
        "first_name": "ESSAM",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-16",
        "last_updated": "2019-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "C55143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "C55143",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

Verify at the official NPI Registry.