Alaa Naim Mansour, D.P.M
Individual provider Active NPI Foot & Ankle Surgery Podiatrist · Dearborn, MI
NPI 1962885699 · NPPES record last updated Oct 21, 2019
Key facts
- NPI
- 1962885699
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- License
- 5901002591 (MI)
- Practice address
- 17000 Executive Plaza Dr Ste 101
Dearborn, MI 48126-2793 - Phone
- (313) 565-4948
- Fax
- (313) 565-4989
- NPI assigned
- Jun 30, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- William M. Scholl College of Podiatric Medicine, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- BC Podiatry, PLLC
Jiab Suleiman DO PC
Bradley E Seel DPM PC
Practice addresses (Care Compare)
13650 10 Mile Rd
South Lyon, MI 48178-9143
Phone (248) 486-1177
17000 Executive Plaza Dr
101 Premiier Orthopedics
Dearborn, MI 48126-2793
Phone (313) 565-4948
3768 Packard St
Suite a
Ann Arbor, MI 48108-2090
Phone (734) 975-1700
89 W S Blvd
Suite 500
Troy, MI 48085-1600
Phone (248) 509-7086
Hospital & facility affiliations
- Corewell Health Wayne Hospital
- Henry Ford Health Warren Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 1-10 |
| Melanoma (skin cancer) excision | 1-10 |
| Removal of tissue | 55 |
| Removal of skin lesions | 73 |
| Removal of nail tissue | 691 |
| Removal or shaving of skin growth | 396 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190108002292 | MI | Practitioner - Podiatry | 8729342365 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jiab Suleiman, DO, P.C. | Current |
Accepting new patients | |
| BC Podiatry PLLC | Podiatrist | Current |
Accepting new patients |
| Bradley E Seel DPM PC | Podiatrist | Current |
Accepting new patients |
| BC Podiatry PLLC | Podiatrist | Past | Accepting new patients |
| United Footcare PA | Podiatrist | Past |
Accepting new patients |
Locations
3768 Packard St
Ste A
Ann Arbor, MI 48108
Phone (734) 975-1700
2050 N Haggerty Rd
Ste 100
Canton, MI 48187
Phone (734) 981-1086
17000 Executive Plaza Dr
Ste 101
Dearborn, MI 48126
Phone (248) 327-7111
30775 Stephenson Hwy
Madison Hts, MI 48071
Phone (248) 733-9904
31017 John R Rd
Madison Hts, MI 48071
Phone (248) 585-1177
13650 10 Mile Rd
South Lyon, MI 48178
Phone (248) 486-1177
89 W South Blvd
Ste 500
Troy, MI 48085
Phone (248) 509-7086
Interoperability endpoints
- alaa.mansour3@direct.secureehrthomas.com
- amansour495195@direct.hfhs.org
- alaa.mansour@direct.secureehrthomas.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 5901002591 | MI | Yes |
Addresses
Primary practice location
17000 Executive Plaza Dr Ste 101
Dearborn, MI 48126-2793
Mailing address
17000 Executive Plaza Dr
Ste 101
Dearborn, MI 48126-2793
Phone (313) 565-4948
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300013898 | Medicaid | IN |
Other providers in Dearborn, MI
- Manor Urdent Care 1
- Manor Urgent Care PC
- Manor Urgent Care, PC
- Manuel Alexander Manrique
- Julia Mansour Jamal Eddine
- Ali Mansour
- Batoul Mansour
- Lena Mansour
- Malek Mansour
- Mariam Hassan Mansour I
All providers in Dearborn, MI · Foot & Ankle Surgery Podiatrist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.