NPIMap

Individual provider Active NPI

Malek Maatouk, M.D.

  • Internal Medicine Physician
  • Michigan City, IN
National Provider Identifier
1972574986
Registry record updated Aug 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01060123A Issued in IN
Practice address
1225 E Coolspring Ave
Michigan City, IN 46360-6312
Phone
(219) 878-5054
Fax
(219) 878-5053
NPI assigned
Jan 28, 2006
Last updated
Aug 9, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2011

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 01060123A IN Primary

Addresses

Primary practice location

1225 E Coolspring Ave
Michigan City, IN 46360-6312

Mailing address

1225 E Coolspring Ave
Michigan City, IN 46360-6312
Phone (219) 878-5054

Other identifiers 3

IdentifierTypeStateIssuer
P00286172OtherMEDICARE RR
000000369964OtherINANTHEM
200509930MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20050427001031 IN Practitioner - Internal Medicine 1658357462 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Network IncGroup PAC ID 3678737012, 378 clinicians
Chesterton Physical Therapy IncGroup PAC ID 3173683984, 191 clinicians

Practice addresses (Care Compare)

3800 Saint Mary Rd
Suite 103
Valparaiso, IN 46383-3986
Phone (219) 464-2123

425 Sand Creek Dr
Chesterton, IN 46304-1589

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01060123AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Network Inc Internal Medicine CurrentSince Jan 31, 2017 Accepting new patients
Healthpartners Medical Group, LLC Past Accepting new patients
Genesys Integrated Group Practice PC Past Accepting new patients

Locations

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

3800 Saint Mary Rd
Ste 103
Valparaiso, IN 46383
Phone (219) 464-2123

Interoperability endpoints

  • Direct secure messaging: mmaatouk69135@ssdirect.comhs.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 9

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": "1138406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312848000000",
    "number": "1972574986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 E COOLSPRING AVE",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463606312",
            "telephone_number": "219-878-5054",
            "fax_number": "219-878-5053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 E COOLSPRING AVE",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463606312",
            "telephone_number": "219-878-5054",
            "fax_number": "219-878-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAATOUK",
        "first_name": "MALEK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-28",
        "last_updated": "2011-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01060123A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00286172",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000369964",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200509930",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Michigan City, IN

Sources for this page

Verify at the official NPI Registry.