NPIMap

Individual provider Active NPI

Mohamad Samah Kalou, MD

  • Addiction Medicine (Family Medicine) Physician
  • Charleston, WV
National Provider Identifier
1619065190
Registry record updated Aug 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
License
22493 Issued in WV
Practice address
5240 Maccorkle Ave SE
Charleston, WV 25304-2122
Phone
(304) 926-2300
Fax
(304) 926-2304
NPI assigned
Oct 10, 2006
Last updated
Aug 26, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 22493 WV
Family Medicine Physician 207Q00000X 35.088590 OH
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X 22493 WV Primary

Addresses

Primary practice location

5240 Maccorkle Ave SE
Charleston, WV 25304-2122

Mailing address

500 Poplar St
Suite 204
South Charleston, WV 25309-1474
Phone (304) 767-7840

Other identifiers 2

IdentifierTypeStateIssuer
001902627OtherWVBCBS
3810006491MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, FL2 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
I20061120000365 WV Practitioner - Family PracticePractitioner - Internal MedicinePractitioner - Emergency Medicine 4183622517 Reassigns benefits to 1 organization
I20250117000397 FL Practitioner - Family PracticePractitioner - Addiction Medicine 4183622517

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mountaineer Family Medicine, Inc.Group PAC ID 5496858102, 6 clinicians

Practice addresses (Care Compare)

258 Hanging Rock Hwy
Logan, WV 25601-5113
Phone (304) 688-9700

4114 1St Ave
Nitro, WV 25143-1304
Phone (304) 755-0119

5240 Maccorkle Ave SE
Charleston, WV 25304-2122
Phone (304) 926-2300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.088590OHMDFamily Medicine Physician
22493WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Commons Drive Family Medicine Multi-Specialty CurrentSince Jan 1, 2025 Accepting new patients
Mountaineer Family Medicine, Inc. Multi-Specialty CurrentSince Jan 1, 2007 Accepting new patients
Phoenix Treatment Center Inc Multi-Specialty CurrentSince Mar 31, 2021 Accepting new patients
Mountaineer Family Medicine, Inc. Multi-Specialty Past Accepting new patients
Mountaineer Family Medicine, Inc. Family Medicine Past Accepting new patients
Mountaineer Family Medicine, Inc. Multi-Specialty PastSince Jun 9, 2024 Accepting new patients

Locations

4012 Commons Dr W
Ste 112
Destin, FL 32541
Phone (304) 552-7412

310 George St
Beckley, WV 25801
Phone (304) 254-9022

511 Blue Prince Rd
Bluefield, WV 24701
Phone (304) 327-0723

5240 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 926-2300

113 Liberty Sq
Hurricane, WV 25526
Phone (304) 552-7414

4114 1st Ave
Nitro, WV 25143
Phone (304) 755-0110

500 Poplar St
Ste 204
South Charleston, WV 25309
Phone (304) 414-2895

Organizations & group practices 7

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.

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": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598400000000",
    "number": "1619065190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 POPLAR ST",
            "address_2": "SUITE 204",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091474",
            "telephone_number": "304-767-7840",
            "fax_number": "304-767-7849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5240 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253042122",
            "telephone_number": "304-926-2300",
            "fax_number": "304-926-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALOU",
        "first_name": "MOHAMAD",
        "middle_name": "SAMAH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "22493",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.088590",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "WV",
            "license": "22493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "001902627",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006491",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.