Individual provider Active NPI

Ahmad Bassel Shughoury, MD

  • Gastroenterology Physician
  • Merrillville, IN
National Provider Identifier
1356343578
Registry record updated May 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
01059363A Issued in IN
Practice address
8895 Broadway
Merrillville, IN 46410-7037
Phone
(219) 738-2081
Fax
(219) 736-4658
NPI assigned
Jun 1, 2005
Last updated
May 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 01059363A IN Primary

Addresses

Primary practice location

8895 Broadway
Merrillville, IN 46410-7037

Mailing address

8558 Broadway
Merrillville, IN 46410-7032
Phone (219) 392-7084

Other practice location 1

7835 Grand Blvd
Hobart, IN 46342-6665
Phone (219) 947-6795

Other practice location 2

3800 Saint Mary Rd Ste 101
Valparaiso, IN 46383-3986
Phone (219) 947-6795

Other identifiers 4

IdentifierTypeStateIssuer
9115389OtherINANTHEM BC/BS
200108230AMedicaidIN
P00204531OtherINRAILROAD MEDICARE
000000346359OtherINANTHEM BC/BS

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041007000220 IN Practitioner - GastroenterologyPractitioner - Internal Medicine 0345209110 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Network IncGroup PAC ID 3678737012, 378 clinicians

Practice addresses (Care Compare)

7835 Grand Blvd
Hobart, IN 46342-6665
Phone (219) 945-4499

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy119
Upper gastrointestinal (GI) endoscopy for acid reflux175

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Network Inc CurrentSince Jul 1, 2020 Accepting new patients

Locations

1500 S Lake Park Ave
#403
Hobart, IN 46342
Phone (219) 947-6795

7835 Grand Blvd
Hobart, IN 46342
Phone (219) 769-2258

8558 Broadway
Merrillville, IN 46410
Phone (219) 392-7084

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

3800 Saint Mary Rd
Ste 303
Valparaiso, IN 46383
Phone (219) 286-3832

3800 Saint Mary Rd
Ste 304
Valparaiso, IN 46383
Phone (219) 947-6795

3800 Saint Mary Rd
Ste 101
Valparaiso, IN 46383
Phone (219) 738-2081

Interoperability endpoints

  • Direct secure messaging: ashughoury4347@ssdirect.comhs.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588636800000",
    "number": "1356343578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8558 BROADWAY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107032",
            "telephone_number": "219-392-7084",
            "fax_number": "219-703-6854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8895 BROADWAY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107037",
            "telephone_number": "219-738-2081",
            "fax_number": "219-736-4658"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7835 Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Hobart",
            "state": "IN",
            "postal_code": "463426665",
            "country_code": "US",
            "telephone_number": "219-947-6795",
            "fax_number": "219-703-6896",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3800 Saint Mary Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463833986",
            "country_code": "US",
            "telephone_number": "219-947-6795",
            "fax_number": "219-703-6896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHUGHOURY",
        "first_name": "AHMAD",
        "middle_name": "BASSEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2020-05-05",
        "certification_date": "2020-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "01059363A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "9115389",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200108230A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00204531",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "000000346359",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

Verify at the official NPI Registry.