NPIMap

Individual provider Active NPI

Housam Soukieh, MD

  • Pulmonary Disease Physician
  • Moberly, MO
National Provider Identifier
1568422673
Registry record updated Aug 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
2014021757 Issued in MO
Practice address
1513 Union Ave
Suite 1600
Moberly, MO 65270-9402
Phone
(660) 263-2400
Fax
(660) 263-5610
NPI assigned
Mar 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 036-101288 IL
Pulmonary Disease Physician 207RP1001X 2014021757 MO Primary

Addresses

Primary practice location

1513 Union Ave
Suite 1600
Moberly, MO 65270-9402

Mailing address

1513 Union Ave
Suite 1600
Moberly, MO 65270-9402
Phone (660) 263-2400

Other identifiers 1

IdentifierTypeStateIssuer
036101288MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20140904002142 MO Practitioner - Internal MedicinePractitioner - Pulmonary Disease 1254482631 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pulmonary Disease
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carroll County Memorial Hospital 64 clinicians
Boone Physician Services LLC 243 clinicians

Practice addresses (Care Compare)

1502 N Jefferson St
Carrollton, MO 64633-1948
Phone (660) 542-1695

1600 E Broadway
Columbia, MO 65201-5844
Phone (573) 815-8000

Hospital & facility affiliations

  • Carroll County Memorial Hospital Hospital, Carrollton, MO, CCN 261332
  • Boone Hospital Center Hospital, Columbia, MO, CCN 260068

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-101288ILMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carroll County Memorial Hospital CurrentSince Nov 1, 2024 Accepting new patients
Boone Physician Services, LLC CurrentSince May 18, 2025 Accepting new patients
Carroll County Memorial Hospital Past Accepting new patients
Midwest Heart and Vein Center, LLC Past Accepting new patients
Allergy and Asthma Educational Specialists, LLC PastSince Oct 3, 2015 Accepting new patients
Carle Health Care Incorporated Pulmonary Disease Past Accepting new patients

Locations

1502 N Jefferson St
Carrollton, MO 64633
Phone (660) 542-1695

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1705 E Broadway
Ste 280
Columbia, MO 65201
Phone (573) 815-7119

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/9785b033-fa30-4746-84ca-c07c9380c88e/
  • FHIR API: https://fhir-usa.unify.chbase.com/org/carrcmh-bfcca679

Organizations & group practices 10

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 3

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": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409097600000",
    "number": "1568422673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1513 UNION AVE",
            "address_2": "SUITE 1600",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652709402",
            "telephone_number": "660-263-2400",
            "fax_number": "660-263-5610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 UNION AVE",
            "address_2": "SUITE 1600",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652709402",
            "telephone_number": "660-263-2400",
            "fax_number": "660-263-5610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUKIEH",
        "first_name": "HOUSAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2014-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036-101288",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MO",
            "license": "2014021757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036101288",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moberly, MO

Sources for this page

Verify at the official NPI Registry.