NPIMap

Individual provider Active NPI

Wessam Boutros Bou-Assaly

  • Diagnostic Radiology Physician
  • Ann Arbor, MI
National Provider Identifier
1851581540
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
M41968 Issued in TX
Practice address
2155 Fuller Rd
Radiology Department/ VA Health Center
Ann Arbor, MI 48105
Phone
(734) 761-7959
NPI assigned
Jul 28, 2007
Last updated
Oct 1, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 4301089243 MI
Neuroradiology Physician 2085N0700X 4301089243 MI
Diagnostic Radiology Physician 2085R0202X M41968 TX Primary
Diagnostic Radiology Physician 2085R0202X 4301089243 MI

Addresses

Primary practice location

2155 Fuller Rd
Radiology Department/ VA Health Center
Ann Arbor, MI 48105

Mailing address

9155 Mirage Lake Dr
Milan, MI 48160-9010
Phone (317) 828-0810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MP
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
I20240830003737 MP Practitioner - Diagnostic Radiology 2163968116 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Lower Navy Hill Rd
Saipan, MP 96950
Phone (670) 234-8950

1 Lower Navy Hill Rd
Saipan, MP 96950-0409

PO Box
Saipan, MP 96950

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301089243MIMDNeuroradiology Physician
M41968TXMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Healthcare Corporation Current Accepting new patients
Calera Inc CurrentSince Mar 1, 2024 Accepting new patients
Commonwealth Healthcare Corporation CurrentSince Apr 28, 2024 Accepting new patients
Commonwealth Healthcare Corporation CurrentSince Apr 28, 2024 Accepting new patients
Lubbock County Hospital District Diagnostic Radiology Past Accepting new patients
Fisher County Hospital District Past Accepting new patients
Martin County Hospital District Past Accepting new patients
Vesta Telemedicine Solutions, PLLC Neuroradiology Past Accepting new patients

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: boutrous.bou-assaly.1@13131.direct.athenahealth.com
  • Direct secure messaging: wessam.boutrous.bou-assaly.1@13131.direct.athenahealth.com

Organizations & group practices 8

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 1

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": "1185580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1851581540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9155 MIRAGE LAKE DR",
            "city": "MILAN",
            "state": "MI",
            "postal_code": "481609010",
            "telephone_number": "317-828-0810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 FULLER RD",
            "address_2": "RADIOLOGY DEPARTMENT/ VA HEALTH CENTER",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48105",
            "telephone_number": "734-761-7959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOU-ASSALY",
        "first_name": "WESSAM",
        "middle_name": "BOUTROS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-28",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301089243",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "MI",
            "license": "4301089243",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "M41968",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301089243",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.