NPIMap

Individual provider Active NPI

Mahmood Fattooh Moosa, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Monroe, MI
National Provider Identifier
1669478681
Registry record updated Jan 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
35067199 Issued in OH
Practice address
15506 S Telegraph Rd
Monroe, MI 48161-5520
Phone
(734) 682-5243
Fax
(888) 677-1987
NPI assigned
Jun 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 35067199 OH Primary

Addresses

Primary practice location

15506 S Telegraph Rd
Monroe, MI 48161-5520

Mailing address

15506 S Telegraph Rd
Monroe, MI 48161-5520
Phone (734) 682-5243

Other identifiers 1

IdentifierTypeStateIssuer
2158454MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI2 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
I20040331000016 OH Practitioner - Endocrinology 8224020581 Reassigns benefits to 1 organization
I20040422000107 MI Practitioner - Endocrinology 8224020581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endocrine Specialists, P.C.Group PAC ID 7416095609, 5 clinicians

Practice addresses (Care Compare)

15506 S Telegraph Rd
Monroe, MI 48161-5520
Phone (419) 724-0004

6855 Spring Valley Dr
Suite 150
Holland, OH 43528-7012
Phone (419) 724-0004

Hospital & facility affiliations

  • Promedica Monroe Regional Hospital Hospital, Monroe, MI, CCN 230099
  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068
  • Mercy St Vincent Medical Center Hospital, Toledo, OH, CCN 360112
  • Promedica Charles and Virginia Hickman Hospital Hospital, Adrian, MI, CCN 230005
  • Wood County Hospital Hospital, Bowling Green, OH, CCN 360029

Merit-based Incentive Payment System (MIPS)

Final score
42.45 of 100Reported as individual
Quality
36.67
Improvement activities
0
Cost
76

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Endocrine Specialists, P.C. Endocrinology, Diabetes & Metabolism CurrentSince Nov 1, 2009 Accepting new patients
Mercy Health - St Anne Hospital LLC Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Endocrine Associates Inc Endocrinology, Diabetes & Metabolism Past Accepting new patients
Partners Physician Group Past Accepting new patients

Locations

15506 S Telegraph Rd
Monroe, MI 48161
Phone (419) 724-0004

6855 Spring Valley Dr
Ste 150
Holland, OH 43528
Phone (419) 724-0004

3156 Dustin Rd
Ste 301
Oregon, OH 43616
Phone (419) 698-7722

Organizations & group practices 5

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 7

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": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294531200000",
    "number": "1669478681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15506 S TELEGRAPH RD",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481615520",
            "telephone_number": "734-682-5243",
            "fax_number": "888-677-1987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15506 S TELEGRAPH RD",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481615520",
            "telephone_number": "734-682-5243",
            "fax_number": "888-677-1987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOSA",
        "first_name": "MAHMOOD",
        "middle_name": "FATTOOH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2011-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "OH",
            "license": "35067199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2158454",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, MI

Sources for this page

Verify at the official NPI Registry.