Rizk M Abdel Moutagaly, MD
Individual provider Active NPI Pediatrics Physician · Russellville, AL
NPI 1528021474 · NPPES record last updated Feb 23, 2010
Key facts
- NPI
- 1528021474
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 22718 (AL)
- Practice address
- 715 Gandy St
Russellville, AL 35653 - Phone
- (256) 332-1175
- Fax
- (256) 332-1171
- NPI assigned
- Apr 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- Other, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
715 Gandy St C
PO Box 580
Russellville, AL 35653-0580
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101122001131 | AL | Practitioner - Pediatric Medicine |
6507052131 | Practice locations: Russellvile, AL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22718 | AL | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 22718 | AL | Yes |
| General Practice Physician | 208D00000X | 22718 | AL |
Addresses
Primary practice location
715 Gandy St
Russellville, AL 35653
Mailing address
PO Box 580
Russellville, AL 35653
Phone (256) 332-1175
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51021621 | Other | AL | BLUE CROSS BLUE SHIELD |
| 000021621 | Medicaid | AL |
Other providers in Russellville, AL
- Affinity Counseling, LLC
- Agilitas USA, Inc
- Alabama CVS Pharmacy, L.L.C.
- Russell Douglas Alexander
- Maria Jeanette Alferez
All providers in Russellville, AL · Pediatrics Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.