WISAM AL-MUTAWALLI MD
NPI 1164005526
Family Medicine in Camillus, NY
About Wisam Al-mutawalli Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WISAM AL-MUTAWALLI MD (NPI 1164005526) is an individual family medicine provider in Camillus, New York, licensed in New York (332191) and active in the NPI registry since May 2021. He is enrolled in Medicare PECOS, is affiliated with Crouse Hospital, and is a graduate of Other (2005).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Wisam Al-mutawalli Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Wisam Al-mutawalli reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Syracuse, NY 13210
- Reassigned Medicare billing, New York enrollment
- 54 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 4
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare 3
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Crouse Hospital
Acute Care Hospitals · Syracuse, NYOswego Hospital
Acute Care Hospitals · Oswego, NYUniversity Hospital S U N Y Health Science Center
Acute Care Hospitals · Syracuse, NYPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 13031 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 12
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Wisam Al-mutawalli's NPI number?
The NPI number for Wisam Al-mutawalli is 1164005526. It was assigned to this individual provider in the NPPES registry on May 4, 2021.
Where is Wisam Al-mutawalli located?
Wisam Al-mutawalli practices at 208 Township Blvd Ste 100, Camillus, NY 13031. The listed phone number is (315) 551-6000.
What is Wisam Al-mutawalli's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Wisam Al-mutawalli enrolled in Medicare?
Yes. Wisam Al-mutawalli is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Wisam Al-mutawalli's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Wisam Al-mutawalli reassigns Medicare benefits to Upstate Family And Preventive Medicine, Inc (Syracuse, NY). 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 Wisam Al-mutawalli's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Wisam Al-mutawalli affiliated with any hospitals?
According to CMS data, Wisam Al-mutawalli is affiliated with Crouse Hospital, Oswego Hospital and University Hospital S U N Y Health Science Center.
When was this NPI record last updated?
The NPPES record for Wisam Al-mutawalli was last updated on October 23, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.
# Wisam Al-Mutawalli, MD · NPI 1164005526
Family Medicine physician in Camillus, New York. Individual provider, active in the CMS NPPES registry since May 4, 2021.
## Identity
- **NPI:** 1164005526 (Entity type: Individual)
- **Enumerated:** May 4, 2021
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** 332191 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 208 TOWNSHIP BLVD, STE 100, Camillus, NY 13031
- **Phone:** (315) 551-6000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Upstate Family And Preventive Medicine, Inc (NPI 1073988911, Syracuse, NY), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2005
## Record status
- **NPPES last updated:** October 23, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1164005526) · Data from the CMS NPPES public registry.