NPIMap

Individual provider Active NPI

Mahmoud Othman, MD

  • Interventional Cardiology Physician
  • Detroit, MI
National Provider Identifier
1508811456
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
4301081581 Issued in MI
Practice address
4160 John R St
Suite 724
Detroit, MI 48201-2020
Phone
(313) 832-8888
Fax
(313) 831-1137
NPI assigned
May 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301081581 MI
Interventional Cardiology Physician 207RI0011X 4301081581 MI Primary
Cardiovascular Disease Physician 207RC0000X 4301081581 MI
Nuclear Cardiology Physician 207UN0901X 4301081581 MI
Vascular Surgery Physician 2086S0129X 4301081581 MI
Vascular & Interventional Radiology Physician 2085R0204X 4301081581 MI
Diagnostic Ultrasound Physician 2085U0001X 4301081581 MI

Addresses

Primary practice location

4160 John R St
Suite 724
Detroit, MI 48201-2020

Mailing address

4160 John R St
Suite 724
Detroit, MI 48201-2020
Phone (313) 832-8888

Other identifiers 1

IdentifierTypeStateIssuer
06144810OtherECFMG

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, OH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060606000215 MI Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology)Practitioner - Nuclear Medicine 5799796868 Reassigns benefits to 2 organizations
I20250318003158 OH Practitioner - Cardiovascular Disease (Cardiology) 5799796868 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fisher-Titus Medical Care LLCGroup PAC ID 6507940566, 82 clinicians

Practice addresses (Care Compare)

272 Benedict Ave
Norwalk, OH 44857-2374
Phone (419) 668-8101

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting11

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fisher-Titus Medical Care LLC CurrentSince Apr 29, 2025 Accepting new patients
Mary Rutan Hospital CurrentSince May 1, 2025 Accepting new patients
Fisher-Titus Medical Center Current Accepting new patients
DO Gardi MD PC Internal Medicine CurrentSince Jul 9, 2013 Accepting new patients
Access and Vascular Care Vascular Surgery CurrentSince Sep 1, 2014 Accepting new patients
Mary Rutan Hospital CurrentSince May 1, 2025 Accepting new patients
Mary Rutan Hospital Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

4160 John R St
Ste 724
Detroit, MI 48201
Phone (313) 831-6842

14555 Levan Rd
Ste 303
Livonia, MI 48154
Phone (734) 367-4603

10861 W 10 Mile Rd
Oak Park, MI 48237
Phone (248) 268-1135

1134 N Main St
Ste 2500
Bellefontaine, OH 43311
Phone (937) 292-3494

205 E Palmer Rd
Bellefontaine, OH 43311
Phone (937) 592-4015

272 Benedict Ave
Ste 2
Norwalk, OH 44857

272 Benedict Ave
Norwalk, OH 44857
Phone (419) 668-1341

Interoperability endpoints

  • Direct secure messaging: mothman2@direct.dmc.org

Organizations & group practices 8

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 11

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": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375747200000",
    "number": "1508811456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4160 JOHN R ST",
            "address_2": "SUITE 724",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012020",
            "telephone_number": "313-832-8888",
            "fax_number": "313-831-1137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 JOHN R ST",
            "address_2": "SUITE 724",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012020",
            "telephone_number": "313-832-8888",
            "fax_number": "313-831-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTHMAN",
        "first_name": "MAHMOUD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2013-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301081581",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MI",
            "license": "4301081581",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301081581",
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "MI",
            "license": "4301081581",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301081581",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MI",
            "license": "4301081581",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "MI",
            "license": "4301081581",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ECFMG",
            "identifier": "06144810",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.