NPIMap

Individual provider Active NPI

Khader Mustafa

  • Rheumatology Physician
  • Sylvania, OH
National Provider Identifier
1881078533
Registry record updated Jan 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
35063837 Issued in OH
Practice address
5700 Monroe St Unit 202
Sylvania, OH 43560
Phone
(567) 585-0115
NPI assigned
Jul 13, 2015
Last updated
Jan 22, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 35063837 OH Primary

Addresses

Primary practice location

5700 Monroe St Unit 202
Sylvania, OH 43560

Mailing address

5700 Monroe St Unit 202
Sylvania, OH 43560-2735
Phone (567) 585-0115

Other practice location 1

30 Severance Cir
Apartment 601
Cleveland Heights, OH 44118-1531
Phone (216) 392-4891

Other practice location 2

5700 Monroe St Unit 202
Sylvania, OH 43560
Phone (567) 585-0115

Other identifiers 1

IdentifierTypeStateIssuer
0892673MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20171122002409 OH Practitioner - Rheumatology 2264799444 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

5700 Monroe St
Sylvania, OH 43560-2767
Phone (567) 585-0005

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35063837OHMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Nov 1, 2017 Accepting new patients
Promedica Central Physicians CurrentSince Nov 1, 2017 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
The Toledo Hospital Past Accepting new patients

Locations

5700 Monroe St
Sylvania, OH 43560
Phone (419) 473-6622

5700 Monroe St
Unit 202
Sylvania, OH 43560
Phone (419) 473-6622

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

Interoperability endpoints

  • Direct secure messaging: kmustafa112313@direct.promedica.org

Organizations & group practices 4

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 7

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": "1436745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548115200000",
    "number": "1881078533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 MONROE ST UNIT 202",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602735",
            "telephone_number": "567-585-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 MONROE ST UNIT 202",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "43560",
            "telephone_number": "567-585-0115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 Severance Cir",
            "address_2": "Apartment 601",
            "address_purpose": "LOCATION",
            "city": "Cleveland Heights",
            "state": "OH",
            "postal_code": "441181531",
            "country_code": "US",
            "telephone_number": "216-392-4891",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5700 Monroe St Unit 202",
            "address_purpose": "LOCATION",
            "city": "Sylvania",
            "state": "OH",
            "postal_code": "43560",
            "country_code": "US",
            "telephone_number": "567-585-0115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUSTAFA",
        "first_name": "KHADER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-13",
        "last_updated": "2019-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "OH",
            "license": "35063837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0892673",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylvania, OH

Sources for this page

Verify at the official NPI Registry.