Wessam Boutros Bou-assaly, is a medicare enrolled "Specialist" physician in Ann Arbor, Michigan. His current practice location is
2155 Fuller Rd, Radiology Department/ Va Health Center, Ann Arbor, Michigan. You can reach out to his office (for appointments etc.) via phone at
(734) 761-7959.
Wessam Boutros Bou-assaly is licensed to practice in Michigan (license number 4301089243) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1851581540.
Physician's Profile
Full Name | Wessam Boutros Bou-assaly |
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Gender | Male |
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Speciality | Specialist |
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Location | 2155 Fuller Rd, Ann Arbor, Michigan |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1851581540
- Provider Enumeration Date: 07/28/2007
- Last Update Date: 02/17/2022
Medicare PECOS Information:
- PECOS PAC ID: 2163968116
- Enrollment ID: I20240830003737
Medical Identifiers
Medical identifiers for Wessam Boutros Bou-assaly such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1851581540 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
2085N0700X | Radiology - Neuroradiology | 4301089243 (Michigan) | Secondary |
2085R0202X | Radiology - Diagnostic Radiology | 4301089243 (Michigan) | Secondary |
174400000X | Specialist | 4301089243 (Michigan) | Primary |
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. Wessam Boutros Bou-assaly allows following entities to bill medicare on his behalf.
Entity Name | Commonwealth Healthcare Corporation |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1285858290 PECOS PAC ID: 7719075167 Enrollment ID: O20071212000093 |
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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. Wessam Boutros Bou-assaly 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 |
Wessam Boutros Bou-assaly, 9155 Mirage Lake Dr, Milan, MI 48160-9010 Ph: (317) 828-0810 | Wessam Boutros Bou-assaly, 2155 Fuller Rd, Radiology Department/ Va Health Center, Ann Arbor, MI 48105 Ph: (734) 761-7959 |
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