NPIMap

Individual provider Active NPI

Mousa Ghassan Dajjani, M.D.

  • Family Medicine Physician
  • Spencer, WV
National Provider Identifier
1336723758
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
33548 Issued in WV
Practice address
200 Hospital Dr
Spencer, WV 25276-1050
Phone
(304) 927-6822
Fax
(304) 927-6814
NPI assigned
May 11, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 33548 WV Primary

Addresses

Primary practice location

200 Hospital Dr
Spencer, WV 25276-1050

Mailing address

200 Hospital Dr
Spencer, WV 25276-1050
Phone (304) 927-6822

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20241105003423 WV Practitioner - Family Practice 0648673269 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospital Development Co.Group PAC ID 4183527476, shared by 9 NPIs, 65 clinicians

Practice addresses (Care Compare)

200 Hospital Dr
Spencer, WV 25276-1050
Phone (304) 927-4444

7313 Charleston Rd
Walton, WV 25286-9613
Phone (304) 577-6815

Hospital & facility affiliations

  • Roane General Hospital Hospital, Spencer, WV, CCN 511306
  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33548WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Development Co CurrentSince Jul 1, 2024 Accepting new patients
Hospital Development Co Current Accepting new patients
Hospital Development Co Current Accepting new patients
Hospital Development Co Family Medicine CurrentSince Jul 1, 2024 Accepting new patients
Hospital Development Co Current Accepting new patients
Hospital Development Corporation Past Accepting new patients

Locations

200 Hospital Dr
Spencer, WV 25276
Phone (304) 927-4444

Organizations & group practices 6

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 12

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": "1620691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1336723758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL DR",
            "city": "SPENCER",
            "state": "WV",
            "postal_code": "252761050",
            "telephone_number": "304-927-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL DR",
            "city": "SPENCER",
            "state": "WV",
            "postal_code": "252761050",
            "telephone_number": "304-927-6822",
            "fax_number": "304-927-6814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAJJANI",
        "first_name": "MOUSA",
        "middle_name": "GHASSAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-11",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "33548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spencer, WV

Sources for this page

Verify at the official NPI Registry.