Fawzy Samy Basta Sr., MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A42961 Issued in CA

Practice address

17075 Devonshire St
Ste 204
Northridge, CA 91325-5408

Phone

(818) 368-8929

Fax

(818) 368-8940

NPI assigned

Oct 24, 2006

Last updated

Jan 20, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Fawzy Basta M D a Professional CorporationGroup PAC ID 4880639814, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southern California Hospital at Hollywood Hospital, Hollywood, CA, CCN 050135
• Providence Holy Cross Medical Center Hospital, Mission Hills, CA, CCN 050278

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

95

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Fawzy Basta M D a Professional Corporation

  • Psychiatry Physician
  • Northridge, CA
  • NPI 1508932500
  Medicare reassignment Care Compare group NPD Authorized official
• Mission City Community Network, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hollywood, CA
  • NPI 1710102009
  Medicare reassignment NPD
• Mission City Community Network, Inc.

  • Primary Care Clinic/Center
  • Monrovia, CA
  • NPI 1063795250
  NPD
• Mission City Community Network, Inc.

  • Community Health Clinic/Center
  • North Hills, CA
  • NPI 1710370747
  NPD

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

• Providence Health System - Southern California

  dba Providence Holy Cross Medical Center

  • General Acute Care Hospital
  • Mission Hills, CA
  • NPI 1477587632
  Care Compare affiliation
• Southern California Healthcare System, Inc

  dba Southern California Hospital at Hollywood, at Van Nuys, at Culver City

  • General Acute Care Hospital
  • Hollywood, CA
  • NPI 1023010113
  Care Compare affiliation

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1043394505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17075 DEVONSHIRE ST",
            "address_2": "STE 204",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251600",
            "telephone_number": "818-368-8929",
            "fax_number": "818-368-8940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17075 DEVONSHIRE ST",
            "address_2": "STE 204",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913255408",
            "telephone_number": "818-368-8929",
            "fax_number": "818-368-8940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTA",
        "first_name": "FAWZY",
        "middle_name": "SAMY",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2012-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A42961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0A429611",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barry R. Halpern, a Prof Corp
• Yvette Barseghian
• Lauren Bartizal
• Michele Bartlett, LCSW, CT
• Lien Bass
• Lashandra Batiste
• Vicki Batt
• Irena Bauman, M.D.
• Jacob K Bauman
• Brenda Bautista

• Psychiatry Physician in Northridge, CA
• Providers in Northridge, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.