Michael Chafic Faddoul, PA-C
Individual provider Active NPI Medical Physician Assistant · Bowling Green, MO
NPI 1659720191 · NPPES record last updated Jul 29, 2024
Key facts
- NPI
- 1659720191
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 2023048261 (MO)
- Practice address
- 8 Town Center Dr
Bowling Green, MO 63334-2803 - Phone
- (573) 324-2241
- Fax
- (573) 324-9854
- NPI assigned
- Jun 6, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hannibal Regional Healthcare System Inc
Practice addresses (Care Compare)
905 Hwy 161
Bowling Green, MO 63334-2431
Phone (573) 324-2241
Hospital & facility affiliations
- Hannibal Regional Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240306000392 | MO | Practitioner - Physician Assistant | 9739472952 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2023048261 | MO | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hannibal Regional Healthcare System Inc | Current |
Accepting new patients | |
| Hannibal Regional Healthcare System, Inc | Current |
Accepting new patients |
Locations
8 Town Center Dr
Bowling Green, MO 63334
Phone (573) 324-2241
6000 Hospital Dr
Hannibal, MO 63401
Phone (573) 248-5460
6000 Hospital Dr
#1257
Hannibal, MO 63401
Phone (573) 248-5460
6500 Hospital Dr
Hannibal, MO 63401
Phone (573) 629-3400
Interoperability endpoints
- https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Medical Physician Assistant | 363AM0700X | 2023048261 | MO | Yes |
Addresses
Primary practice location
8 Town Center Dr
Bowling Green, MO 63334-2803
Mailing address
PO Box 1239
Hannibal, MO 63401-1239
Phone (573) 248-5403
Other practice location 1
6000 Hospital Dr
Hannibal, MO 63401-6887
Phone (573) 248-5211
Other practice location 2
6500 Hospital Dr
Hannibal, MO 63401-6890
Phone (573) 629-3480
Other providers in Bowling Green, MO
- Amanda Renee Dietrich
- John Thomas Dixon
- Doctor'S Health Group
- Elijah J Carroll
- Amy E Etsell
- Family Circle Therapeutic Services LLC
- Family Health Pharmacies Inc
- Samuel W Ferreri
- Susan Eileen Fessler
- Alexa Fisher
All providers in Bowling Green, MO · Medical Physician Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.