Active NPI
Assy Yacoub, D.O.
- Internal Medicine Physician
- Scott AFB, IL
National Provider Identifier
1760478234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 02002494A
- Practice address
- 310 W Losey St
Scott AFB, IL 62225-5250 - Phone
- (618) 256-3434
- NPI assigned
- Sep 21, 2005
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 02002494A | IN | Primary |
Addresses
Primary practice location
310 W Losey St
Scott AFB, IL 62225-5250
Mailing address
455 Winchester PL
Fairview Heights, IL 62208-3870
Phone (618) 236-9480
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 |
|---|---|---|---|---|
| I20130312000455 | FL | Order and Referring Only - Internal Medicine | 5395990634 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1760478234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "455 WINCHESTER PL",
"city": "FAIRVIEW HEIGHTS",
"state": "IL",
"postal_code": "622083870",
"telephone_number": "618-236-9480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 W LOSEY ST",
"city": "SCOTT AFB",
"state": "IL",
"postal_code": "622255250",
"telephone_number": "618-256-3434"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YACOUB",
"first_name": "ASSY",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-21",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IN",
"license": "02002494A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scott AFB, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.