Active NPI
Saba Madhoun, PA
- Physician Assistant
- Southgate, MI
National Provider Identifier
1871958744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601008284
- Practice address
- 15150 Fort St
Southgate, MI 48195-1302 - Phone
- (734) 282-4800
- Fax
- (734) 282-9302
- NPI assigned
- Dec 21, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 5601008284 | MI | Primary |
Addresses
Primary practice location
15150 Fort St
Southgate, MI 48195-1302
Mailing address
15150 Fort
Southgate, MI 48195
Phone (734) 282-4800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38-2546610 | Other | MI | BLUE CROSS BLUE SHIELD |
| 38-2546610 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220623001430 | PA | Practitioner - Physician Assistant | 0446520365 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Main Line Healthcare
Practice addresses (Care Compare)
100 E Lancaster Ave
Wynewood, PA 19096-3450
154 Exton Square Mall
Exton, PA 19341-2440
Phone (484) 565-8500
830 Old Lancaster Rd
Bryn Mawr, PA 19010-3118
Hospital & facility affiliations
- Main Line Hospital Lankenau
- Riddle Memorial Hospital
- Bryn Mawr Hospital
- Paoli Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- smadhoun450639@direct.hfhs.org
Organizations & group practices 1
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 4
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": "1450656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1871958744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15150 FORT",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "48195",
"telephone_number": "734-282-4800",
"fax_number": "734-282-9302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15150 FORT ST",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481951302",
"telephone_number": "734-282-4800",
"fax_number": "734-282-9302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADHOUN",
"first_name": "SABA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-21",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601008284",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "38-2546610",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38-2546610",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.