Active NPI
Mutaz Shaheen
- Student in an Organized Health Care Education/Training Program
- Bronx, NY
National Provider Identifier
1760164602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 234 E 149TH St
Bronx, NY 10451-5504 - Phone
- (718) 579-5000
- NPI assigned
- Aug 1, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
234 E 149TH St
Bronx, NY 10451-5504
Mailing address
1169 Hoe Ave Apt 4C
Bronx, NY 10459-4425
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260611004825 | FL | Practitioner - Internal Medicine | 6204308075 |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 2020
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
770 W Granada Blvd
Suite 101
Ormond Beach, FL 32174-5179
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690848000000",
"number": "1760164602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1169 HOE AVE APT 4C",
"city": "BRONX",
"state": "NY",
"postal_code": "104594425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "234 E 149TH ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104515504",
"telephone_number": "718-579-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAHEEN",
"first_name": "MUTAZ",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-01",
"last_updated": "2023-08-01",
"certification_date": "2023-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.