Samuel Issam Mallouhi, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MA061762 Issued in NJ

Practice address

1031 McBride Ave
Suite D205
Woodland Park, NJ 07424-2559

Phone

(973) 237-9055

Fax

(973) 237-9053

NPI assigned

Jun 9, 2006

Last updated

Jul 1, 2013By 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

Other identifiers 1

Other names 1

• Mr. Issam Mallouhi Other name

Medicare fee-for-service enrollment

Enrolled in NJ

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 PracticeAlso: Internal Medicine

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph's University Medical Center Inc Hospital, Paterson, NJ, CCN 310019
• Chilton Medical Center Hospital, Pompton Plains, NJ, CCN 310017

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samuel.mallouhi.2@32084.direct.athenahealth.com

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.

• Primary Care Medical Practice, LLC

  • Specialist
  • Woodland Park, NJ
  • NPI 1912113002
  Medicare reassignment NPD Authorized official
• Ahs Hospital Corp.

  dba Chilton Medical Center

  • General Acute Care Hospital
  • Pompton Plains, NJ
  • NPI 1811994809
  NPD (past)
• Emergency Physician Associates of North Jersey P C

  • Emergency Medicine Physician
  • Summit, NJ
  • NPI 1497783419
  NPD (past)
• St Josephs University Medical Center Inc.

  • General Acute Care Hospital
  • Paterson, NJ
  • NPI 1669462420
  NPD (past)
• Inphynet Primary Care Physicians Southeast PC

  • Emergency Medicine Physician
  • Columbus, GA
  • NPI 1770521460
  NPD (past)
• Riverside Medical Center

  dba Riverside Surgical Clinic

  • Clinic/Center
  • Franklinton, LA
  • NPI 1104290949
  NPD (past)
• Riverside Medical Center

  dba Riverside Cardiology Clinic

  • Clinic/Center
  • Franklinton, LA
  • NPI 1538634977
  NPD (past)
• Teaneck Emergency Physicians PA

  • Emergency Medicine Physician
  • Teaneck, PA
  • NPI 1972569606
  NPD (past)

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

• Ahs Hospital Corp.

  dba Chilton Medical Center

  • General Acute Care Hospital
  • Pompton Plains, NJ
  • NPI 1811994809
  Care Compare affiliation
• St Josephs University Medical Center Inc.

  • General Acute Care Hospital
  • Paterson, NJ
  • NPI 1669462420
  Care Compare affiliation

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372636800000",
    "number": "1659312098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 MCBRIDE AVE",
            "address_2": "SUITE D205",
            "city": "WOODLAND PARK",
            "state": "NJ",
            "postal_code": "074242559",
            "telephone_number": "973-237-9055",
            "fax_number": "973-237-9053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 MCBRIDE AVE",
            "address_2": "SUITE D205",
            "city": "WOODLAND PARK",
            "state": "NJ",
            "postal_code": "074242559",
            "telephone_number": "973-237-9055",
            "fax_number": "973-237-9053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLOUHI",
        "first_name": "SAMUEL",
        "middle_name": "ISSAM",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2013-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "MA61762",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA061762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7726201",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ISSAM",
            "last_name": "MALLOUHI",
            "prefix": "MR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Alfakelis Liz
• Sandra Lopez, LCSW
• M.T.T.T. Medical Transport LLC.
• Sheila Mack, MSW
• Noha Malique
• Anel Iveth Marquez, AGPCNP-BC
• Shannon Marren, PA-C
• Michael Joseph Martino, MD
• McBride Anesthesia LLC
• McBride Imaging Center LLC

• Internal Medicine Physician in Woodland Park, NJ
• Providers in Woodland Park, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2013; 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.