NPIMap

Individual provider Active NPI

Moustafa M Eldick, M.D.

  • Internal Medicine Physician
  • Crescent City, FL
National Provider Identifier
1962592907
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME0064833 Issued in FL
Practice address
899 N Summit St
Crescent City, FL 32112-2109
Phone
(386) 698-1088
Fax
(386) 698-1099
NPI assigned
Oct 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME0064833 FL Primary

Addresses

Primary practice location

899 N Summit St
Crescent City, FL 32112-2109

Mailing address

899 N Summit St
Crescent City, FL 32112-2109
Phone (386) 698-1088

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20090402000560 FL Practitioner - Internal Medicine 7113074469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

899 N Summit St
Crescent City, FL 32112-2109
Phone (386) 689-1088

Hospital & facility affiliations

  • Mederi Caretenders Home health agency, Brooksville, FL, CCN 107500
  • Brooks Rehabilitation Home Health Home health agency, Palatka, FL, CCN 109754
  • Legacy Home Health Care Inc Home health agency, Starke, FL, CCN 687032
  • Centerwell Home Health Home health agency, Gainesville, FL, CCN 107486
  • HCA Florida Putnam Hospital Hospital, Palatka, FL, CCN 100232
  • The Pavilion at Crescent Lake Nursing home, Crescent City, FL, CCN 105808
  • Radiant Nursing and Rehab at Palatka Nursing home, Palatka, FL, CCN 105805

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions11
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
64833FLMDPharmacist
ME0064833FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Rural Health Inc Internal Medicine CurrentSince Oct 1, 1998 Accepting new patients

Locations

899 N Summit St
Crescent City, FL 32112
Phone (386) 689-1088

126 S County Road 315
Interlachen, FL 32148
Phone (386) 684-4685

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Pavilion at Crescent LakeCrescent City, FL, CCN 105808 Skilled nursing facility Adp of the SNF May 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 8

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": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195516800000",
    "number": "1962592907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "899 N SUMMIT ST",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321122109",
            "telephone_number": "386-698-1088",
            "fax_number": "386-698-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "899 N SUMMIT ST",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321122109",
            "telephone_number": "386-698-1088",
            "fax_number": "386-698-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELDICK",
        "first_name": "MOUSTAFA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2007-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0064833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crescent City, FL

Sources for this page

Verify at the official NPI Registry.