Individual provider Active NPI

Youssef Moustafa, DPM

  • Student in an Organized Health Care Education/Training Program
  • Indianapolis, IN
National Provider Identifier
1336727114
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
41000488A Issued in IN
Practice address
10122 E 10TH St Ste 230
Indianapolis, IN 46229-2664
Phone
(173) 355-7356
NPI assigned
Apr 1, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 41000488A IN Primary

Addresses

Primary practice location

10122 E 10TH St Ste 230
Indianapolis, IN 46229-2664

Mailing address

10122 E 10TH St Ste 230
Indianapolis, IN 46229-2664
Phone (173) 355-7356

Other practice location 1

7800 El Camino Real Apt 2109
Colma, CA 94014-3179
Phone (323) 243-8174

Other identifiers 1

IdentifierTypeStateIssuer
300092003MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240627001249 IN Order and Referring Only - PodiatryPractitioner - Podiatry 9739623000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Interoperability endpoints

  • Direct secure messaging: ymoustafa622714@ecommunitydirect.com

NPI Registry JSON

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1336727114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10122 E 10TH ST STE 230",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462292664",
            "telephone_number": "173-355-7356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10122 E 10TH ST STE 230",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462292664",
            "telephone_number": "173-355-7356"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7800 El Camino Real Apt 2109",
            "address_purpose": "LOCATION",
            "city": "Colma",
            "state": "CA",
            "postal_code": "940143179",
            "country_code": "US",
            "telephone_number": "323-243-8174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOUSTAFA",
        "first_name": "YOUSSEF",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-01",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "41000488A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300092003",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.