Individual provider Active NPI

Mahmoud Hassouba, MD

  • Plastic and Reconstructive Surgery Physician
  • Memphis, TN
National Provider Identifier
1437534682
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
63540 Issued in TN
Practice address
1068 Cresthaven Rd Ste 500
Memphis, TN 38119-0846
Phone
(901) 866-8525
Fax
(901) 302-2525
NPI assigned
Jul 29, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 63540 TN
Plastic and Reconstructive Surgery Physician 2086S0122X 63540 TN Primary

Addresses

Primary practice location

1068 Cresthaven Rd Ste 500
Memphis, TN 38119-0846

Mailing address

1068 Cresthaven Rd Ste 300
Memphis, TN 38119-0809
Phone (901) 866-8864

Other practice location 1

262 Danny Thomas Pl
Memphis, TN 38105-3678
Phone (901) 595-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20220211000665 TN Practitioner - Plastic and Reconstructive Surgery 6204229412 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut Medical Group IncGroup PAC ID 3173435369, 98 clinicians

Practice addresses (Care Compare)

877 Jefferson Ave
Memphis, TN 38103-2807
Phone (901) 866-8053

Hospital & facility affiliations

  • Regional One Health Hospital, Memphis, TN, CCN 440152

Merit-based Incentive Payment System (MIPS)

Final score
88.15 of 100Reported as group
Quality
59.97
Promoting interoperability
100
Improvement activities
40
Cost
80.93

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63540TNMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Jude Children'S Research Hospital, Inc. CurrentSince Apr 10, 2023 Accepting new patients
Ut Medical Group, Inc. CurrentSince Jan 2, 2022 Accepting new patients
Ut Medical Group Inc Plastic and Reconstructive Surgery CurrentSince Jan 2, 2022 Accepting new patients

Locations

1068 Cresthaven Rd
Ste 300
Memphis, TN 38119
Phone (901) 683-0024

1407 Union Ave
Ste 700
Memphis, TN 38104
Phone (901) 866-8360

262 Danny Thomas Pl
Memphis, TN 38105
Phone (888) 226-4343

1068 Cresthaven Rd
Ste 500
Memphis, TN 38119
Phone (901) 476-2727

930 Madison Ave
Ste 200
Memphis, TN 38103
Phone (901) 448-6650

877 Jefferson Ave
Memphis, TN 38103
Phone (901) 448-5893

Interoperability endpoints

  • Direct secure messaging: mhassouba45313@mlh.direct-ci.com

Organizations & group practices 3

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 1

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": "1438128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1437534682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD STE 300",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190809",
            "telephone_number": "901-866-8864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD STE 500",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190846",
            "telephone_number": "901-866-8525",
            "fax_number": "901-302-2525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "262 Danny Thomas Pl",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381053678",
            "country_code": "US",
            "telephone_number": "901-595-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HASSOUBA",
        "first_name": "MAHMOUD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-29",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "TN",
            "license": "63540",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TN",
            "license": "63540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.