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MUSTAFA MUSTAFA DPM
NPI 1104529015
Podiatrist - Foot & Ankle Surgery in Southlake, TX

Active since March 22, 2023PECOS Enrolled
1940 E STATE HIGHWAY 114, SOUTHLAKE, TX 76092(817) 424-3668(817) 442-8637 Get Directions Write a Review

NPPES record last updated: June 1, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 1, 2026, Mar 22, 2023 (2 updates tracked since 2023).

About Mustafa Mustafa Dpm NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MUSTAFA MUSTAFA DPM (NPI 1104529015) is an individual foot & ankle surgery provider in Southlake, Texas, licensed in Texas (692306) and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS, maintains a secondary practice location in Detroit, and is a graduate of Kent State University College Of Podiatric Medicine (2023).

NPPES Registry Identity

NPI1104529015
Entity TypeIndividualMale
Primary Taxonomy213ES0103X
Provider Legal NameMUSTAFA MUSTAFACredential: DPM
Location Address1940 E STATE HIGHWAY 114Southlake, TX 76092-6526
Mailing Address1940 E State Highway 114Southlake, TX 76092-6526 · (817) 424-3668 · Fax (817) 442-8637
Phone(817) 424-3668
Fax(817) 442-8637
Sole ProprietorNo
Medical School CMSKent State University College Of Podiatric MedicineGraduated 2023
Enumeration DateMarch 22, 2023
Last NPPES UpdateJune 1, 20262 updates tracked since enumeration
NPPES CertifiedJune 1, 2026
✔ NPI 1104529015 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatrist · Foot & Ankle SurgeryPodiatric Medicine & Surgery Service Providers
Taxonomy Code213ES0103X
License✔ Licensed in TX · 692306
1940 E STATE HIGHWAY 114, Southlake, TX 76092
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Secondary Practice Location 1

Location 122201 Moross Rd Ste 250Detroit, MI 48236-2175 · Phone (313) 343-3423 · Fax (313) 343-3401

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mustafa Mustafa Dpm is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5092173542
PECOS Enrollment IDI20260701002539
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Mustafa Mustafa reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Hm Podiatry PA
Same address
Primary Podiatric Medicine
1940 E STATE HWY 114, SUITE 150
Southlake, TX 76092
  • Reassigned Medicare billing, Texas enrollment
  • 9 clinicians in this Medicare group
NPI 1376738971 (817) 424-3668

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. LISA ALICE REDDING PT
Physical Therapist
1940 E STATE HIGHWAY 114, SUITE 150
SOUTHLAKE, TX 76092
Tarrant County (817) 424-3668
PAUL THOMAS MARCIANO DPM
Podiatrist
1940 E STATE HIGHWAY 114, SUITE 150
SOUTHLAKE, TX 76092
Tarrant County (817) 424-3668

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mustafa Mustafa's NPI number?

The NPI number for Mustafa Mustafa is 1104529015. It was assigned to this individual provider in the NPPES registry on March 22, 2023.

Where is Mustafa Mustafa located?

Mustafa Mustafa practices at 1940 E State Highway 114, Southlake, TX 76092. The listed phone number is (817) 424-3668.

What is Mustafa Mustafa's specialty?

The primary specialty registered for this NPI is Podiatrist, specializing in Foot & Ankle Surgery, with taxonomy code 213ES0103X.

Is Mustafa Mustafa enrolled in Medicare?

Yes. Mustafa Mustafa is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mustafa Mustafa's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mustafa Mustafa reassigns Medicare benefits to Hm Podiatry PA (Southlake, TX). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mustafa Mustafa's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mustafa Mustafa accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 2 other insurers list Mustafa Mustafa as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mustafa Mustafa was last updated on June 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.