Individual provider Active NPI

Mohamed Ayman Abousetta

  • General Practice Physician
  • Saint Louis, MO
National Provider Identifier
1710755780
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
2023028530 Issued in MO
Practice address
5920 Dr Martin Luther King Dr
Saint Louis, MO 63112-3516
Phone
(314) 389-5737
NPI assigned
Dec 19, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2023028530 MO
General Practice Physician 208D00000X 2023028530 MO Primary

Addresses

Primary practice location

5920 Dr Martin Luther King Dr
Saint Louis, MO 63112-3516

Mailing address

5920 Dr Martin Luther King Dr
Saint Louis, MO 63112-3516
Phone (314) 389-5737

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2023028530MOMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1702944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1710755780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 DR MARTIN LUTHER KING DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631123516",
            "telephone_number": "314-389-5737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5920 DR MARTIN LUTHER KING DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631123516",
            "telephone_number": "314-389-5737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABOUSETTA",
        "first_name": "MOHAMED",
        "middle_name": "AYMAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-19",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2023028530",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "2023028530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.