Deactivated NPI 1003815069 Deactivated / Inactive NPI Male Practitioner

Dr. Mamdouh H Hassaballa , MD

General Practice • Riverwoods, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Mamdouh Hassaballa has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 20, 2005

NPI Deactivation Date January 29, 2026

Total Practice Duration ~21 Years of Practice (2005 – 2026)

Professional Overview & Biography Verified Profile Summary

Dr. Mamdouh Hassaballa, MD was a registered General Practice practicing in Riverwoods, IL. Throughout an active medical career spanning 21 years, Dr. Hassaballa provided care at the practice location at 1105 MILWAUKEE AVE until profile deactivation on 2026-01-29.

Historical Medicare Part B clinical services included principal care management services for a single high-risk disease, first, subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least, subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

1105 Milwaukee Ave

Riverwoods, IL 600153512

Telephone 8473255110

Fax 8473255114

Associated Practice Facility / Clinic

🏢 Tamid Medical Group Facility NPI 1689744245

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Riverwoods, IL

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 10.5 Yrs

State Avg: 30.9 Yrs

Regional Practice Density

2 Specialists

Practicing in Riverwoods, IL (355 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

39.0% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99424 Principal care management services for a single high-risk disease, first 30 minutes provided personally by qualified health care professional, per calendar month.	757	100	$120.00	$70.65
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	669	149	$135.00	$103.30
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	37	30	$115.00	$70.70
99496 Transitional care management services for problem of high complexity	36	36	$350.00	$179.22
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	28	27	$170.00	$126.52
99315 Nursing facility discharge day management, 30 minutes or less	21	18	$140.00	$77.65

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	871	176	$135.00	$110.29
99424 Principal care management services for a single high-risk disease, first 30 minutes provided personally by qualified health care professional, per calendar month.	660	85	$120.00	$76.18
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	92	49	$50.00	$49.21
99315 Nursing facility discharge day management, 30 minutes or less	28	24	$140.00	$84.75
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	26	25	$170.00	$138.72

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	1,095	179	$129.42	$94.38
99358 Prolonged patient service without direct patient contact first hour	879	129	$200.00	$115.43
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	164	42	$50.00	$49.20
99424 Principal care management services for a single high-risk disease, first 30 minutes provided personally by qualified health care professional, per calendar month.	71	18	$120.00	$77.64
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	31	31	$170.00	$133.31
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	29	16	$61.03	$45.78
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	28	23	$115.00	$72.06
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	24	24	$150.00	$136.17
99315 Nursing facility discharge day management, 30 minutes or less	19	17	$140.00	$75.56

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	329	161	$120.24	$95.82
99358 Prolonged patient service without direct patient contact first hour	223	114	$200.00	$118.17
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	22	22	$170.00	$136.06
99315 Nursing facility discharge day management, 30 minutes or less	18	18	$140.00	$76.95
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	12	12	$150.00	$141.06

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	1,370	335	$120.00	$93.27
99358 Prolonged patient service without direct patient contact first hour	888	234	$200.00	$114.69
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	105	97	$105.00	$70.64
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	67	65	$170.00	$132.26
99315 Nursing facility discharge day management, 30 minutes or less	44	38	$140.00	$75.66
99318 Nursing facility annual assessment, typically 30 minutes	18	18	$125.00	$98.64

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	1,197	278	$120.00	$93.74
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	490	219	$105.00	$70.61
99358 Prolonged patient service without direct patient contact first hour	215	82	$200.00	$114.43
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	57	56	$170.00	$133.44
99315 Nursing facility discharge day management, 30 minutes or less	45	44	$140.00	$75.10
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	15	15	$54.00	$44.89

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	1,260	214	$105.00	$69.09
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	795	189	$120.00	$91.43
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	381	89	$50.00	$32.10
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	82	80	$170.00	$129.82
99315 Nursing facility discharge day management, 30 minutes or less	57	57	$140.00	$72.42

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	2,592	320	$105.00	$71.85
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	1,033	227	$120.00	$94.84
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	475	108	$50.00	$33.56
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	113	113	$170.00	$135.53
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	91	91	$225.00	$175.62
99495 Transitional care management services for problem of at least moderate complexity	69	68	$200.00	$114.72
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	64	64	$150.00	$119.10
99315 Nursing facility discharge day management, 30 minutes or less	57	57	$140.00	$76.08

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License IL 036069096

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners

Sohail Dharani , APN

Nurse Practitioner

NPI 1053950410

Advanced Practice Nurse

Dr. Jerry Sanders , MD

Family Medicine

NPI 1083626899

Doctor of Medicine (M.D.)

Dr. Myrlie Casco , MD

Family Medicine

NPI 1093768004

Doctor of Medicine (M.D.)

Dr. Tom Klein , MD

Internal Medicine

NPI 1326094194

Doctor of Medicine (M.D.)

Dr. Vishnu Madireddy , MD

Internal Medicine

NPI 1811063761

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events

⚠️

NPI Profile Deactivated January 29, 2026

Record deactivated on January 29, 2026

✅

NPI Profile Active December 16, 2015

NPI status registered as active in NPPES database

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Updated Practice Location December 16, 2015

Registered at 1105 MILWAUKEE AVE, RIVERWOODS, IL 600153512 (Tel: 8473255110)

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Updated Business Mailing Address December 16, 2015

Registered at 1105 MILWAUKEE AVE, RIVERWOODS, IL 600153512 (Tel: 8473255110)

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Provider Name / Credentials Updated December 16, 2015

Recorded as MAMDOUH HASSABALLA, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 16, 2015

General Practice (License #036069096 in IL)

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Initial NPI Registration & Enumeration July 20, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1003815069

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: July 20, 2005

Last Update: December 16, 2015

Deactivation Date: January 29, 2026

Update or Correct Profile

Mailing Address

1105 Milwaukee Ave

Riverwoods, IL 600153512

Phone: 8473255110

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.