NPIMap

Individual provider Active NPI

Mariam Wassef Hanna

  • Diagnostic Radiology Physician
  • El Segundo, CA
National Provider Identifier
1013228246
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME125175 Issued in FL
Practice address
2330 Utah Ave Ste 200
El Segundo, CA 90245-4817
Phone
(281) 766-0959
NPI assigned
Jun 22, 2010
Last updated
Jan 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X ME125175 FL Primary

Addresses

Primary practice location

2330 Utah Ave Ste 200
El Segundo, CA 90245-4817

Mailing address

PO Box 100374
Gainesville, FL 32610-0374
Phone (352) 265-0291

Other practice location 1

1600 SW Archer Rd
Gainesville, FL 32610-0374
Phone (352) 265-0291

Other identifiers 1

IdentifierTypeStateIssuer
017387200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160622002426 FL Practitioner - Diagnostic Radiology 4789822545 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mori Bean and Brooks IncGroup PAC ID 8820077878, 966 clinicians
Tower Imaging LLCGroup PAC ID 2860470077, 95 clinicians

Practice addresses (Care Compare)

1 Tampa General Cir
Tampa, FL 33606-3571
Phone (904) 399-5550

1301 W Kennedy Blvd
Tampa, FL 33606-1848
Phone (904) 399-5550

2 Tampa General Cir
Tampa, FL 33606-3571
Phone 81325327211937

2001 Kingsley Ave
Orange Park, FL 32073-5148
Phone (904) 399-5550

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
47.54 of 100Reported as apm
Quality
38.49
Promoting interoperability
0
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.22 of 100Reported as group
Quality
95.56
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
78.06 of 100Reported as group
Quality
72.79
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Tower Imaging LLC Diagnostic Radiology CurrentSince Sep 1, 2024 Accepting new patients
Tower Imaging LLC Diagnostic Radiology Current Accepting new patients
Tower Imaging LLC Diagnostic Radiology CurrentSince Sep 1, 2024 Accepting new patients
Mori Bean and Brooks Inc Diagnostic Radiology CurrentSince May 25, 2024 Accepting new patients

Locations

2330 Utah Ave
#200
El Segundo, CA 90245
Phone (424) 213-9368

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

13695 US Highway 1
Sebastian, FL 32958
Phone (772) 589-3185

2106 S Lois Ave
Tampa, FL 33629
Phone (813) 844-4200

14499 N Dale Mabry Hwy
Ste 150
Tampa, FL 33618
Phone (813) 968-6998

2 Tampa General Cir
Tampa, FL 33606
Phone (813) 259-8500

2115 Little Rd
Trinity, FL 34655
Phone 7278418225410

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1013228246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100374",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100374",
            "telephone_number": "352-265-0291",
            "fax_number": "352-265-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 UTAH AVE STE 200",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902454817",
            "telephone_number": "281-766-0959"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326100374",
            "country_code": "US",
            "telephone_number": "352-265-0291",
            "fax_number": "352-265-0279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANNA",
        "first_name": "MARIAM",
        "middle_name": "WASSEF",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-22",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME125175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017387200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Segundo, CA

Sources for this page

Verify at the official NPI Registry.