NPIMap

Individual provider Active NPI

Ahmed Hisham Khaleel Sammour, MD

  • Internal Medicine Physician
  • Englewood, NJ
National Provider Identifier
1760977789
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
30443 Issued in WV
Practice address
350 Engle Street
Department of Medicine
Englewood, NJ 07631
Phone
(201) 894-3143
NPI assigned
Jun 22, 2018
Last updated
Aug 4, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 30443 WV Primary

Addresses

Primary practice location

350 Engle Street
Department of Medicine
Englewood, NJ 07631

Mailing address

350 Engle St Dept of
Englewood, NJ 07631-1808

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20210811002461 WV Practitioner - Internal Medicine 7214331388 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City Hospital IncGroup PAC ID 3375444524, 155 clinicians

Practice addresses (Care Compare)

2500 Hospital Dr
Martinsburg, WV 25401-3402
Phone (304) 260-1443

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
City Hospital, Inc. Internal Medicine CurrentSince Nov 19, 2024 Accepting new patients
Hospitalist Medicine Physicians of West Virginia- TCG PLLC Internal Medicine CurrentSince Oct 15, 2022 Accepting new patients
Hospitalist Medicine Physicians of West Virginia, PLLC Internal Medicine CurrentSince Aug 4, 2021 Accepting new patients
City Hospital Inc Current Accepting new patients
City Hospital, Inc Past Accepting new patients

Locations

2500 Hospital Dr
Martinsburg, WV 25401
Phone (304) 233-4134

4605 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 414-4800

Interoperability endpoints

  • Direct secure messaging: asammour302972@direct.wvuhsdirect.com

Organizations & group practices 5

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1529625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1760977789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 ENGLE ST DEPT OF",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076311808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 ENGLE STREET",
            "address_2": "DEPARTMENT OF MEDICINE",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "07631",
            "telephone_number": "201-894-3143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMMOUR",
        "first_name": "AHMED",
        "middle_name": "HISHAM KHALEEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-22",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "30443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, NJ

Sources for this page

Verify at the official NPI Registry.