Organization Active NPI

Hisham Abukamleh MD. Inc

  • Primary Care Clinic/Center
  • Apple Valley, CA
National Provider Identifier
1043855208
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
HISHAM ABUKAMLEH MD. INC
Practice address
18144 US Highway 18 Ste 140
Apple Valley, CA 92307-2219
Phone
(760) 515-4003
Fax
(760) 515-4503
NPI assigned
Nov 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Authorized official

Name
Hisham Jihad Abukamleh, MDNPI 1144689647
Title
Doctor
Phone
(760) 515-4003

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

18144 US Highway 18 Ste 140
Apple Valley, CA 92307-2219

Mailing address

18182 US Highway 18 Ste 107
Apple Valley, CA 92307-2200
Phone (760) 515-4003

Other identifiers 1

IdentifierTypeStateIssuer
1144689647MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200228001893 CA Part B Supplier - Clinic/Group Practice 4183051303 Receives reassigned benefits from 1 practitioner
Practice locations: Apple Valley, CA; Victorville, CA

National Provider Directory

National Provider Directory

Locations

18144 US Highway 18
Ste 140
Apple Valley, CA 92307
Phone (760) 242-5500

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GJHACD

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1043855208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18182 US HIGHWAY 18 STE 107",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923072200",
            "telephone_number": "760-515-4003",
            "fax_number": "760-515-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18144 US HIGHWAY 18 STE 140",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923072219",
            "telephone_number": "760-515-4003",
            "fax_number": "760-515-4503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HISHAM ABUKAMLEH MD. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "last_updated": "2024-07-10",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "ABUKAMLEH",
        "authorized_official_first_name": "HISHAM",
        "authorized_official_middle_name": "JIHAD",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "760-515-4003",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144689647",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.