Osama Khaled Ali Kaddourah, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

D0092318 Issued in MD

Practice address

1640 Woodbrooke Dr
Salisbury, MD 21804-8501

Phone

(410) 912-5640

NPI assigned

Jun 10, 2015

Reactivated

Feb 8, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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

Internal MedicineAlso: Gastroenterology

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Maryland Physicians PAGroup PAC ID 2769394808, 395 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Umd Upper Chesapeake Medical Center Hospital, Bel Air, MD, CCN 210049
• University of Maryland Medical Center Hospital, Baltimore, MD, CCN 210002

Merit-based Incentive Payment System (MIPS)

Final score

82.92 of 100Reported as group

Quality

74.47

Promoting interoperability

92

Improvement activities

40

Cost

75.27

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• University of Maryland Physicians P.a.

  • Cardiovascular Disease Physician
  • Baltimore, MD
  • NPI 1689623175
  Medicare reassignment Care Compare group NPD
• Tidalhealth Specialty Care, LLC

  • Medical Specialty Clinic/Center
  • Salisbury, MD
  • NPI 1619504735
  Medicare reassignment NPD
• University of Maryland Physicians P.a.

  • Gastroenterology Physician
  • Largo, MD
  • NPI 1619860194
  NPD
• University of Maryland Physicians PA

  • Gastroenterology Physician
  • Baltimore, MD
  • NPI 1548210156
  NPD

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

• University of Maryland Medical Center, LLC

  • General Acute Care Hospital
  • Baltimore, MD
  • NPI 1174660120
  Care Compare affiliation
• Upper Chesapeake Medical Center, Inc.

  • General Acute Care Hospital
  • Bel Air, MD
  • NPI 1598761355
  Care Compare affiliation

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

{
    "created_epoch": "1433894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1619358181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 WOODBROOKE DR",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218048501",
            "telephone_number": "410-912-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 WOODBROOKE DR",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218048501",
            "telephone_number": "410-912-5640"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 Holmes Street",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "64108",
            "country_code": "US",
            "telephone_number": "816-404-4862",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KADDOURAH",
        "first_name": "OSAMA",
        "middle_name": "KHALED ALI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-10",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "deactivation_date": "2016-01-20",
        "reactivation_date": "2016-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2015017267",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "2015017267",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MD",
            "license": "D0092318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Salisbury, MD
• Providers in Salisbury, MD by specialty
• Gastroenterology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.