NPIMap

Individual provider Active NPI

David Peter Mouallem, DO

  • Internal Medicine Physician
  • Nanticoke, PA
National Provider Identifier
1730132200
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS007906L Issued in PA
Practice address
4 E Main St
Nanticoke, PA 18634-1602
Phone
(570) 735-7474
Fax
(570) 735-2921
NPI assigned
May 18, 2006
Last updated
Oct 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS007906L PA Primary

Addresses

Primary practice location

4 E Main St
Nanticoke, PA 18634-1602

Mailing address

4 E Main St
Nanticoke, PA 18634-1602
Phone (570) 258-3939

Other identifiers 7

IdentifierTypeStateIssuer
0015426480004MedicaidPA
002460OtherPAFIRST PRIORITY HEALTH
20815OtherPAGEISINGER HEALTH PLAN
787165OtherPAHIGHMARK BLUE SHIELD
787165OtherPAFIRST PRIORITY LIFE
129122OtherPAHEALTH AMERICA
020017400OtherPABLACK LUNG

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address david.mouallem.1@21771.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101118000448 PA Practitioner - Internal Medicine 0143315036 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Commonwealth Physician Network LLCGroup PAC ID 2668696592, 63 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

4 E Main St
Nanticoke, PA 18634-1602
Phone (570) 735-7474

506 Hazle St
Wilkes Barre, PA 18702-4646
Phone (570) 270-4366

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.17 of 100Reported as apm
Quality
78.34
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Physician Network LLC Internal Medicine CurrentSince Feb 8, 2014 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Intermed Physicians Inc Internal Medicine PastSince Jan 1, 2001 Accepting new patients

Locations

4 E Main St
Nanticoke, PA 18634
Phone (570) 258-3939

200 S River St
Plains, PA 18705
Phone (570) 821-1100

Interoperability endpoints

  • Direct secure messaging: david.mouallem.1@21771.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 55

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1730132200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 E MAIN ST",
            "city": "NANTICOKE",
            "state": "PA",
            "postal_code": "186341602",
            "telephone_number": "570-258-3939",
            "fax_number": "570-258-0165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 E MAIN ST",
            "city": "NANTICOKE",
            "state": "PA",
            "postal_code": "186341602",
            "telephone_number": "570-735-7474",
            "fax_number": "570-735-2921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUALLEM",
        "first_name": "DAVID",
        "middle_name": "PETER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS007906L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015426480004",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH",
            "identifier": "002460",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN",
            "identifier": "20815",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "787165",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY LIFE",
            "identifier": "787165",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA",
            "identifier": "129122",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "020017400",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "david.mouallem.1@21771.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "4 E Main St",
            "city": "Nanticoke",
            "state": "PA",
            "country_code": "US",
            "postal_code": "186341602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Nanticoke, PA

Sources for this page

Verify at the official NPI Registry.