NPIMap

Individual provider Active NPI

Soundos K Moualla, MD

  • Interventional Cardiology Physician
  • Prescott, AZ
National Provider Identifier
1396853461
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
48512 Issued in AZ
Practice address
1001 Willow Creek Rd Ste 2200
Prescott, AZ 86301-1614
Phone
(928) 445-6025
Fax
(928) 778-3026
NPI assigned
Aug 28, 2006
Last updated
Feb 3, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 4301093355 MI
Interventional Cardiology Physician 207RI0011X 48512 AZ Primary

Addresses

Primary practice location

1001 Willow Creek Rd Ste 2200
Prescott, AZ 86301-1614

Mailing address

PO Box 10880
Prescott, AZ 86304-0880
Phone (602) 406-4886

Other identifiers 1

IdentifierTypeStateIssuer
48512OtherAZARIZONA LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20140528001701 AZ Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 2264436294 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1003 Willow Creek Rd
Prescott, AZ 86301-1641
Phone (928) 445-2700

802 Ainsworth Dr
Suite a
Prescott, AZ 86301-1623
Phone (928) 445-6025

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting47
Pacemaker insertion or repair1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301093355MIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yavapai Regional Medical Center Physician Care LLC Cardiovascular Disease CurrentSince Sep 1, 2017 Accepting new patients
Yrmc Hospice CurrentSince Nov 1, 2020 Accepting new patients
Yavapai Regional Medical Center Physician Care LLC Cardiovascular Disease CurrentSince Sep 1, 2017 Accepting new patients
Yavapai Pathology Associates PLC Current Accepting new patients
Yavapai Community Hospital Association CurrentSince Nov 1, 2020 Accepting new patients
Prescott Gastroenterology Past Accepting new patients
Board of Trustees of Howard Community Hospital Cardiovascular Disease Past Accepting new patients

Locations

1001 Willow Creek Rd
Ste 2200
Prescott, AZ 86301
Phone (928) 445-6025

1003 Willow Creek Rd
Prescott, AZ 86301
Phone (928) 445-2700

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

802 Ainsworth Dr
Ste A
Prescott, AZ 86301
Phone (928) 445-6025

7700 E Florentine Rd
Ste 206
Prescott Valley, AZ 86314
Phone (928) 442-8117

Organizations & group practices 7

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 7

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": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1396853461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "602-406-4886",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 WILLOW CREEK RD STE 2200",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011614",
            "telephone_number": "928-445-6025",
            "fax_number": "928-778-3026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUALLA",
        "first_name": "SOUNDOS",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-28",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301093355",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "AZ",
            "license": "48512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA LICENSE",
            "identifier": "48512",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.