Mahader Nigussie Wossene, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

125.084740 Issued in IL

Practice address

3231 Euclid Ave
Berwyn, IL 60402-3471

Phone

(708) 783-3401

Fax

(708) 783-3341

NPI assigned

Jun 26, 2024

Last updated

Jun 26, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1710722400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3231 EUCLID AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023471",
            "telephone_number": "708-783-3401",
            "fax_number": "708-783-3341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3231 EUCLID AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023471",
            "telephone_number": "708-783-3401",
            "fax_number": "708-783-3341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOSSENE",
        "first_name": "MAHADER",
        "middle_name": "NIGUSSIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.084740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.