Individual provider Active NPI

Mohammed Mahmoud Moursi, MD

  • Vascular Surgery Physician
  • Little Rock, AR
National Provider Identifier
1871504126
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
E-0588 Issued in AR
Practice address
4300 W 7TH St
112PV/LR
Little Rock, AR 72205-5446
Phone
(501) 257-6864
NPI assigned
Aug 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 73333 TN
Vascular Surgery Physician 2086S0129X E-0588 AR Primary

Addresses

Primary practice location

4300 W 7TH St
112PV/LR
Little Rock, AR 72205-5446

Mailing address

9 Alsace CT
Little Rock, AR 72223-9574
Phone (501) 257-6864

Other practice location 1

1 Childrens Way # 837
Little Rock, AR 72202-3500
Phone (501) 364-1100

Other practice location 2

880 Madison Ave
Memphis, TN 38103-3409
Phone (901) 545-7272

Other identifiers 1

IdentifierTypeStateIssuer
128055001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, TN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080723000169 AR Practitioner - Vascular SurgeryPractitioner - General Surgery 6608949789 Reassigns benefits to 4 organizations
I20250410003454 TN Practitioner - Vascular Surgery 6608949789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
University of Michigan Medical School, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arkansas Childrens Professional Services Organization LLCGroup PAC ID 4688183148, 180 clinicians
Ut Regional One Physicians IncGroup PAC ID 5698993418, 314 clinicians

Practice addresses (Care Compare)

1 Childrens Way
Little Rock, AR 72202-3500
Phone (501) 364-2526

880 Madison Ave
Memphis, TN 38103-3409
Phone (901) 545-6969

Hospital & facility affiliations

  • Regional One Health Hospital, Memphis, TN, CCN 440152

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
73333TNMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Arkansas for Medical Sciences CurrentSince Sep 8, 1995 Accepting new patients
Arkansas Childrens Professional Services Organization LLC CurrentSince Jul 7, 2025 Accepting new patients
Ut Regional One Physicians Inc CurrentSince Apr 1, 2025 Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Sep 8, 1995 Accepting new patients
Ut Regional One Physicians Inc CurrentSince Apr 1, 2025 Accepting new patients
Arkansas Children'S Hospital CurrentSince Jun 18, 2013 Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Jun 18, 2013 Accepting new patients
Arkansas Childrens Hospital CurrentSince Jun 18, 2013 Accepting new patients

Locations

4300 W 7th St
#112
Little Rock, AR 72205
Phone (501) 257-6864

4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278

1 Childrens Way
#837
Little Rock, AR 72202
Phone (501) 364-3646

1 Childrens Way
Little Rock, AR 72202
Phone (501) 364-1874

1 Childrens Way
#653
Little Rock, AR 72202
Phone (501) 614-2006

4301 W Markham St
Little Rock, AR 72205
Phone (501) 603-1278

877 Jefferson Ave
Memphis, TN 38103
Phone (901) 448-5893

6215 Humphreys Blvd
Ste 201
Memphis, TN 38120
Phone (901) 866-8085

880 Madison Ave
Memphis, TN 38103
Phone (901) 515-3500

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 and National Provider Directory roles.

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": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1871504126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 ALSACE CT",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722239574",
            "telephone_number": "501-257-6864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 W 7TH ST",
            "address_2": "112PV/LR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055446",
            "telephone_number": "501-257-6864"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Childrens Way # 837",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722023500",
            "country_code": "US",
            "telephone_number": "501-364-1100",
            "fax_number": "501-364-4082",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "880 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381033409",
            "country_code": "US",
            "telephone_number": "901-545-7272",
            "fax_number": "901-545-8292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOURSI",
        "first_name": "MOHAMMED",
        "middle_name": "MAHMOUD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "TN",
            "license": "73333",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AR",
            "license": "E-0588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128055001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.