NPIMap

Individual provider Active NPI

Mohamad M Kassem, M.D.

  • Nephrology Physician
  • Stockbridge, GA
National Provider Identifier
1891726121
Registry record updated Dec 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
040934 Issued in GA
Practice address
3580 Cameron Parkway
Stockbridge, GA 30281
Phone
(770) 996-6446
Fax
(770) 996-6279
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 040934 GA Primary

Addresses

Primary practice location

3580 Cameron Parkway
Stockbridge, GA 30281

Mailing address

3580 Cameron Parkway
Stockbridge, GA 30281
Phone (770) 996-6446

Other identifiers 1

IdentifierTypeStateIssuer
00681678BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20100915000063 GA Practitioner - Nephrology 5991763583 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southside Kidney Clinics, PCGroup PAC ID 7810955408, 3 clinicians

Practice addresses (Care Compare)

3580 Cameron Pkwy
Stockbridge, GA 30281-7816
Phone (770) 996-6446

Hospital & facility affiliations

  • Stockbridge Dialysis Clinic,LLC Dialysis facility, Stockbridge, GA, CCN 112753
  • Spalding County Dialysis Dialysis facility, Griffin, GA, CCN 112696
  • South Henry Dialysis Center Dialysis facility, McDonough, GA, CCN 112799
  • Ellenwood Dialysis Center Dialysis facility, Ellenwood, GA, CCN 112847
  • Wellstar Spalding Medical Center Hospital, Griffin, GA, CCN 110031
  • Piedmont Henry Hospital Hospital, Stockbridge, GA, CCN 110191
  • Piedmont Fayette Hospital Hospital, Fayetteville, GA, CCN 110215
  • Northside Hospital Hospital, Atlanta, GA, CCN 110161

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southside Kidney Clinics, PC Nephrology CurrentSince Jun 2, 1997 Accepting new patients
South Henry Dialysis LLC PastSince Aug 7, 2007 Accepting new patients
Stockbridge Dialysis Clinic, LLC PastSince Sep 12, 2005 Accepting new patients
Ellenwood Dialysis Center, LLC PastSince Jul 26, 2011 Accepting new patients
Spalding County Dialysis, LLC PastSince Jun 14, 2006 Accepting new patients

Locations

1570 Williamson Rd
Griffin, GA 30224

744 S 8th St
Griffin, GA 30224
Phone (770) 467-8116

3580 Cameron Pkwy
Stockbridge, GA 30281
Phone (770) 996-6446

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CCDIAA

Organizations & group practices 5

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 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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386806400000",
    "number": "1891726121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3580 CAMERON PARKWAY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "30281",
            "telephone_number": "770-996-6446",
            "fax_number": "770-996-6279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3580 CAMERON PARKWAY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "30281",
            "telephone_number": "770-996-6446",
            "fax_number": "770-996-6279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASSEM",
        "first_name": "MOHAMAD",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2013-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "040934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00681678B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

Verify at the official NPI Registry.