Moutamn Sadoun, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

4301111192 Issued in MI

Practice address

29000 Little Mack Ave Ste B
Saint Clair Shores, MI 48081-3018

Phone

(586) 774-8811

Fax

(586) 774-6773

NPI assigned

Jun 21, 2012

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

General Surgery

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Henry Ford Health St. John HospitalGroup PAC ID 3173424082, 332 clinicians

Acute Care Surgeons PCGroup PAC ID 6002956265, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: msadoun1149960@direct.hfhs.org

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.

• Henry Ford Health St. John Hospital

  dba St John North Shores Hospital

  • Podiatrist
  • Harrison Township, MI
  • NPI 1043478910
  Medicare reassignment Care Compare group NPD
• Acute Care Surgeons PC

  • Trauma Surgery Physician
  • Detroit, MI
  • NPI 1730415753
  Medicare reassignment Care Compare group
• Henry Ford Health River District Hospital

  dba Henry Ford River District Hospital

  • Family Medicine Physician
  • East China, MI
  • NPI 1265486245
  Medicare reassignment NPD
• Henry Ford Semi Medical Group

  • Family Medicine Physician
  • Warren, MI
  • NPI 1942317631
  Medicare reassignment NPD
• Henry Ford Health River District Hospital

  • General Acute Care Hospital
  • East China, MI
  • NPI 1619941333
  NPD
• Henry Ford Health St. John Hospital

  dba Henry Ford St John Hospital

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1912965088

  Surgery

  NPD
• Henry Ford Semi Medical Group

  • Endocrinology, Diabetes & Metabolism Physician
  • Novi, MI
  • NPI 1114133485

  Surgery

  NPD
• Henry Ford Semi Medical Group

  • Family Medicine Physician
  • Warren, MI
  • NPI 1174537500

  Surgery

  NPD
• Henry Ford Health St. John Hospital

  dba St John Hospital and Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  NPD
• Ascension Macomb Oakland Hospital

  dba Michigan Neuro-Ophthalmology & Oculoplastic Surgery

  • Ophthalmology Physician
  • Madison Heights, MI
  • NPI 1114962461
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Henry Ford Health St. John Hospital

  dba St John Hospital and Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1528321809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29000 LITTLE MACK AVE STE B",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813018",
            "telephone_number": "586-774-8811",
            "fax_number": "586-774-6773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29000 LITTLE MACK AVE STE B",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813018",
            "telephone_number": "586-774-8811",
            "fax_number": "586-774-6773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SADOUN",
        "first_name": "MOUTAMN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-21",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "R73297",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301111192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miranda Rysiewicz, PT, DPT
• Richard T Saady, LMT
• Davis Brian Sabo
• Sacred Heart Rehabilitation Center, Inc.
• Sacred Oak Counseling, P.L.L.C.
• Erica Sagese
• David James Saglimbene, D.D.S.
• Mohammed Sahly, MD
• Sailaja Datla MD PLC
• Saint Clair Family Pharmacy LLC (Lifesmart RX Pharmacy)

• Surgery Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.