NPIMap

Individual provider Active NPI

Mohanad Ali Alfaqih, M.D

  • Pulmonary Disease Physician
  • Poplar Bluff, MO
National Provider Identifier
1598085235
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
2015034886 Issued in MO
Practice address
3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone
(573) 778-2600
NPI assigned
Jun 4, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301096285 MI
Pulmonary Disease Physician 207RP1001X 2015034886 MO Primary

Addresses

Primary practice location

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573

Mailing address

2799 W. Grand Blvd.
Henry Ford Hospital
Detroit, MI 48202-2608

Other practice location 1

3098 Oak Grove Rd
Poplar Bluff, MO 63901-8938
Phone (573) 778-2600

Other names 1

  • Muhannad Ali Ramadan Other name

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
I20161019000625 MO Practitioner - Pulmonary Disease 3072746205 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poplar Bluff Hma Physician Management, LLCGroup PAC ID 5092769703, 41 clinicians

Practice addresses (Care Compare)

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone (573) 776-2600

Hospital & facility affiliations

  • Poplar Bluff Regional Medical Center Hospital, Poplar Bluff, MO, CCN 260119
  • Piggott Community Hospital Hospital, Piggott, AR, CCN 041330
  • Saint Francis Medical Center Hospital, Cape Girardeau, MO, CCN 260183
  • Mercy Hospital Stoddard Hospital, Dexter, MO, CCN 260160

Merit-based Incentive Payment System (MIPS)

Final score
91.41 of 100Reported as apm
Quality
79.26
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Poplar Bluff Hma Physician Management, LLC CurrentSince Sep 18, 2016 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

3098 Oak Grove Rd
Poplar Bluff, MO 63901
Phone (573) 778-2600

3100 Oak Grove Rd
Rombauer, MO 63901
Phone (573) 776-2000

Interoperability endpoints

  • Direct secure messaging: mohanad.alfaqih.1@8825.direct.athenahealth.com

Organizations & group practices 2

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 5

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": "1275609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1598085235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2799 W. GRAND BLVD.",
            "address_2": "HENRY FORD HOSPITAL",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 OAK GROVE RD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639011573",
            "telephone_number": "573-778-2600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3098 Oak Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "639018938",
            "country_code": "US",
            "telephone_number": "573-778-2600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALFAQIH",
        "first_name": "MOHANAD",
        "middle_name": "ALI",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-04",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301096285",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MO",
            "license": "2015034886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MUHANNAD",
            "last_name": "RAMADAN",
            "middle_name": "ALI",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.