NPIMap

Organization Active NPI

Egyptian Spine Clinic

  • Orthopaedic Surgery of the Spine Physician
  • Mount Vernon, IL
National Provider Identifier
1932572872
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
036.136254 Issued in IL
Legal business name
EGYPTIAN SPINE CLINIC
Practice address
412 S 34TH St Ste 101
Mount Vernon, IL 62864-6021
Phone
(618) 231-6121
NPI assigned
Oct 31, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Authorized official

Name
Dr. Ahmed Salem Mohamed, MDNPI 1053633461
Title
Owner
Phone
(618) 231-6121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XS0117X 036.136254 IL Primary

Addresses

Primary practice location

412 S 34TH St Ste 101
Mount Vernon, IL 62864-6021

Mailing address

412 S 34TH St Ste 101
Mount Vernon, IL 62864-6021
Phone (618) 231-6121

Other practice location 1

1007 M L King Dr
Centralia, IL 62801-3001
Phone (443) 509-3678

Other identifiers 1

IdentifierTypeStateIssuer
036136254MedicaidIL

National Provider Directory

National Provider Directory

Locations

412 S 34th St
Ste 101
Mount Vernon, IL 62864
Phone (443) 509-3678

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1446249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606694400000",
    "number": "1932572872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 S 34TH ST STE 101",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646021",
            "telephone_number": "618-231-6121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 S 34TH ST STE 101",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646021",
            "telephone_number": "618-231-6121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1007 M L King Dr",
            "address_purpose": "LOCATION",
            "city": "Centralia",
            "state": "IL",
            "postal_code": "628013001",
            "country_code": "US",
            "telephone_number": "443-509-3678",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EGYPTIAN SPINE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-31",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "AHMED",
        "authorized_official_middle_name": "SALEM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-231-6121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "IL",
            "license": "036.136254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036136254",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.