NPIMap

Organization Active NPI

Nasser Moukaddem, M.D., P.a.

  • Internal Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1831220235
Registry record updated Dec 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME71447 Issued in FL
Legal business name
NASSER MOUKADDEM, M.D., P.A.
Doing business as
Nasser Moukaddem, M.D., P.A.
Practice address
4226 Central Ave
St Petersburg, FL 33711-1140
Phone
(727) 321-3915
Fax
(727) 328-0975
NPI assigned
Mar 8, 2007
Last updated
Dec 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2013

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

Authorized official

Name
Nasser Moukaddem, M.D.NPI 1124008883
Title
President
Phone
(727) 321-3915

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X ME71447 FL Primary

Addresses

Primary practice location

4226 Central Ave
St Petersburg, FL 33711-1140

Mailing address

4226 Central Ave
St Petersburg, FL 33711-1140
Phone (727) 321-3915

Other identifiers 2

IdentifierTypeStateIssuer
260638100MedicaidFL
110189691OtherFLRAILROAD MEDICARE

Other names 1

  • Nasser Moukaddem, M.D., P.A. Doing business as

National Provider Directory

National Provider Directory

Locations

4230 Central Ave
St Petersburg, FL 33711
Phone (727) 321-3915

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386115200000",
    "number": "1831220235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4226 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337111140",
            "telephone_number": "727-321-3915",
            "fax_number": "727-328-0975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4226 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337111140",
            "telephone_number": "727-321-3915",
            "fax_number": "727-328-0975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NASSER MOUKADDEM, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2013-12-04",
        "status": "A",
        "authorized_official_last_name": "MOUKADDEM",
        "authorized_official_first_name": "NASSER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-321-3915",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME71447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260638100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110189691",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nasser Moukaddem, M.D., P.A.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2013; 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.