Dr Mamdouh H Hassaballa, MD is a medicare enrolled "General Practice" physician in Riverwoods, Illinois. He went to Rush Medical College Of Rush University and graduated in 1984 and has 40 years of diverse experience with area of expertise as General Practice. He is a member of the group practice Tamid Medical Group and his current practice location is
1105 Milwaukee Ave, Riverwoods, Illinois. You can reach out to his office (for appointments etc.) via phone at
(847) 325-5110.
Dr Mamdouh H Hassaballa is licensed to practice in Illinois (license number 036069096) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1003815069.
Physician's Profile
| Full Name | Dr Mamdouh H Hassaballa |
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| Gender | Male |
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| Speciality | General Practice |
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| Experience | 40 Years |
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| Location | 1105 Milwaukee Ave, Riverwoods, Illinois |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Mamdouh H Hassaballa attended and graduated from Rush Medical College Of Rush University in 1984
NPI Data:
- NPI Number: 1003815069
- Provider Enumeration Date: 07/20/2005
- Last Update Date: 12/16/2015
Medicare PECOS Information:
- PECOS PAC ID: 2062693534
- Enrollment ID: I20110217000168
Medical Identifiers
Medical identifiers for Dr Mamdouh H Hassaballa such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1003815069 | NPI | - | NPPES |
| 036069096 | Medicaid | IL | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208D00000X | General Practice | 036069096 (Illinois) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Tamid Medical Group | 4587560594 | 7 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Mamdouh H Hassaballa allows following entities to bill medicare on his behalf.
| Entity Name | Tamid Medical Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1689744245
PECOS PAC ID: 4587560594
Enrollment ID: O20031210000657 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Mamdouh H Hassaballa is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Mamdouh H Hassaballa, MD
1105 Milwaukee Ave,
Riverwoods, IL 60015-3512
Ph: (847) 325-5110 | Dr Mamdouh H Hassaballa, MD
1105 Milwaukee Ave,
Riverwoods, IL 60015-3512
Ph: (847) 325-5110 |
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