Larissa Fomum Mugri, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

5841 S Maryland Ave # Mc5068
Chicago, IL 60637-1443

Phone

(773) 702-9109

NPI assigned

Apr 21, 2021

Last updated

Apr 21, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Michigan State University College of Human Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wake Forest Emergency ProvidersGroup PAC ID 7012819816, 497 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carolinas Medical Center-Northeast Hospital, Concord, NC, CCN 340001
• Atrium Health University City Hospital, Charlotte, NC, CCN 340166

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lfomummugri2913857@carolinashealthcaresystem.direct-ci.com

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.

• Wake Forest Emergency Providers

  • Multi-Specialty Clinic/Center
  • Statesville, NC
  • NPI 1396216735
  Medicare reassignment Care Compare group NPD

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

• The Charlotte-Mecklenburg Hospital Authority

  dba Atrium Health University City

  • General Acute Care Hospital
  • Charlotte, NC
  • NPI 1346297892
  Care Compare affiliation
• The Charlotte-Mecklenburg Hospital Authority

  dba Atrium Health Cabarrus

  • General Acute Care Hospital
  • Concord, NC
  • NPI 1487866315
  Care Compare affiliation
• The Charlotte-Mecklenburg Hospital Authority

  dba Atrium Health Cabarrus Inpatient Psych Unit

  • Psychiatric Hospital Unit
  • Concord, NC
  • NPI 1629283866
  Care Compare affiliation

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

{
    "created_epoch": "1618963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1851973721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 HARVESTER DR STE 110",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276686",
            "telephone_number": "773-702-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE # MC5068",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371443",
            "telephone_number": "773-702-9109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMUM MUGRI",
        "first_name": "LARISSA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-21",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phoebe A. Foltz
• Christine Folz, MS, OTR/L
• Victoria Katherine Fombelle, LPC
• Fomeak Inc
• Adam Fominaya, PHD
• Tracy Fondren-Lusk
• Brian Fondren, FNP-C
• Nia Denise Foney
• Michal Fonfa, SLP
• Robert Fong II, MD, PHD

• Student in an Organized Health Care Education/Training Program in Chicago, IL
• Providers in Chicago, IL by specialty
• Student in an Organized Health Care Education/Training Program in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; 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.

Verify at the official NPI Registry.