ALAA EDDIN TAHBOUB PA-C
NPI 1689225443
Physician Assistant in Detroit, MI

Q: What is Alaa Eddin Tahboub's NPI number?

The NPI number for Alaa Eddin Tahboub is 1689225443. It was assigned to this individual provider in the NPPES registry on September 24, 2019.

Q: What is Alaa Eddin Tahboub's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Active since September 24, 2019PECOS EnrolledAccepts Medicare Assignment

4771 MICHIGAN AVE, DETROIT, MI 48210(313) 897-2600(313) 897-2424 Get Directions Write a Review

NPPES record last updated: December 13, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 13, 2024, Sep 24, 2019 (2 updates tracked since 2019).

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About Alaa Eddin Tahboub Pa-c NPPES

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

ALAA EDDIN TAHBOUB PA-C (NPI 1689225443) is an individual physician assistant in Detroit, Michigan, licensed in Illinois (085007807) and active in the NPI registry since September 2019. He is enrolled in Medicare PECOS, is affiliated with Osf Little Company Of Mary Medical Center, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1689225443

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameALAA EDDIN TAHBOUBCredential: PA-C

Location Address4771 MICHIGAN AVEDetroit, MI 48210-9718

Mailing Address17827 Maisons DrClinton Twp, MI 48038-3805 · (810) 845-6450

Phone(313) 897-2600

Fax(313) 897-2424

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateSeptember 24, 2019

Last NPPES UpdateDecember 13, 20242 updates tracked since enumeration

NPPES CertifiedDecember 13, 2024

✔ NPI 1689225443 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in IL · 085007807

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X · License 5601009631 (MI)

4771 MICHIGAN AVE, Detroit, MI 48210

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Alaa Eddin Tahboub Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3173934528

PECOS Enrollment IDI20201116003050

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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Osf Little Company Of Mary Medical Center

Acute Care Hospitals · Evergreen Park, IL

3/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number140179

Location2800 W 95th StEvergreen Park, IL 60805 · Cook County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48210 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$90.76 typical visit price

range $58.04 – $177.36

Typical copayment $22.69 (range $14.51 – $44.34)

Most-billed visit code 99203

Established Patient

$72.38 typical visit price

range $18.32 – $143.49

Typical copayment $18.09 (range $4.58 – $35.87)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

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

MR. MATTHEW NEDWICKI PA-C

Physician Assistant