Samer Ahmad Ali-Hasan, M.D.
Individual provider Active NPI Cardiovascular Disease Physician · Midland, MI
NPI 1699869503 · NPPES record last updated Dec 4, 2024
Key facts
- NPI
- 1699869503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 4301101928 (MI)
- Practice address
- 2660 W Sugnet Rd
Midland, MI 48640-2647 - Phone
- (989) 832-0900
- Fax
- (989) 633-0349
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150831001001 | NY | Practitioner - Cardiovascular Disease (Cardiology) | 0446323976 | Reassigns benefits to 1 organization |
| I20241010001214 | IL | Practitioner - Interventional Cardiology |
0446323976 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202142 | LA | MD | Registered Nurse |
| 01063288A | IN | MD | Cardiovascular Disease Physician |
| 35.094208 | OH | MD | Cardiovascular Disease Physician |
| MD202142 | LA | MD | Interventional Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deaconess Illinois Specialty Clinic, Inc. | Current |
Accepting new patients | |
| St. Peter'S Health Partners Medical Associates, P.C. | Cardiovascular Disease | Current |
Accepting new patients |
| Deaconess Illinois Specialty Clinic, Inc. | Cardiovascular Disease | Current | Accepting new patients |
| Southern Illinois Medical Services, NFP | Current |
Accepting new patients | |
| Deaconess Illinois Specialty Clinic, Inc. | Cardiovascular Disease | Current |
Accepting new patients |
| Prairie Cardiovascular Consultants LTD | Cardiovascular Disease | Current |
Accepting new patients |
| Fauster Cameron Inc. | Past | Accepting new patients |
Locations
409 W Oak St
Carbondale, IL 62901
Phone (618) 536-2565
2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300
303 S Commercial St
Harrisburg, IL 62946
Phone (618) 767-6050
3331 W Deyoung St
Marion, IL 62959
Phone (618) 985-9140
619 E Mason St
#4P57
Springfield, IL 62701
619 E Mason St
Ste 4P57
Springfield, IL 62701
619 E Mason St
Ste 4
Springfield, IL 62701
2 Palisades Dr
Albany, NY 12205
2 New Hampshire Ave
Troy, NY 12180
Phone (518) 272-0331
Interoperability endpoints
- salihasan80112@sih.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 01063288A | IN | |
| Cardiovascular Disease Physician | 207RC0000X | 35.094208 | OH | |
| Cardiovascular Disease Physician | 207RC0000X | 036121333 | IL | |
| Interventional Cardiology Physician | 207RI0011X | MD202142 | LA | |
| Interventional Cardiology Physician | 207RI0011X | 036121333 | IL | |
| Cardiovascular Disease Physician | 207RC0000X | 4301101928 | MI | Yes |
Addresses
Primary practice location
2660 W Sugnet Rd
Midland, MI 48640-2647
Mailing address
2660 W Sugnet Rd
Midland, MI 48640-2647
Phone (989) 832-0900
Other practice location 1
619 E Mason St Ste 4P57
Springfield, IL 62701-1034
Phone (217) 788-0706
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1141500 | Medicaid | LA |
Other providers in Midland, MI
- Wendie Aldrich
- Alexander a Horbal DO PLC
- Mackenzie Anne Alexander
- Nicole Lynn Alexander
- Zachary Alexander
- Ishani Ali
- Broderick Allan
- Tracey M Allan
- Ava Allen
- Britney Allen
All providers in Midland, MI · Cardiovascular Disease Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.