Fariahh Fazil, FNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209019228 Issued in IL

Practice address

2 Good Samaritan Way Ste 235
Mount Vernon, IL 62864-2476

Phone

(618) 899-3980

NPI assigned

Oct 28, 2019

Sex

Female

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

Other names 1

• Faria F Imdad Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Group practices

Beacon Health Medical PCGroup PAC ID 1658804760, 36 clinicians

Parcare Community Health Network IncGroup PAC ID 4981823390, 99 clinicians

Nuvance Health Medical Practice PCGroup PAC ID 1658468442, 578 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vassar Brothers Medical Center Hospital, Poughkeepsie, NY, CCN 330023

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722

Interoperability endpoints

• Direct secure messaging: ffazil@yourcarecommunity.org

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

• Beacon Health Medical PC

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1679393052
  Medicare reassignment Care Compare group NPD
• Nuvance Health Medical Practice PC

  • Internal Medicine Physician
  • Poughkeepsie, NY
  • NPI 1437358033

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Parcare Community Health Network Inc

  • Multi-Specialty Clinic/Center
  • Brooklyn, NY
  • NPI 1730454083
  Medicare reassignment Care Compare group NPD
• Peyman Younesi MD PLLC

  • Internal Medicine Physician
  • Fresh Meadows, NY
  • NPI 1891053328
  Medicare reassignment NPD
• Parcare Community Health Network Inc

  • Multi-Specialty Clinic/Center
  • Brooklyn, NY
  • NPI 1942795943
  NPD

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

• Vassar Brothers Hospital

  • General Acute Care Hospital
  • Poughkeepsie, NY
  • NPI 1740233899
  Care Compare affiliation
• Vassar Brothers Medical Center

  • Clinical Medical Laboratory
  • Poughkeepsie, NY
  • NPI 1780052514

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1572220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1053954503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955860",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631952551",
            "telephone_number": "636-498-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY STE 235",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642476",
            "telephone_number": "618-899-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZIL",
        "first_name": "FARIAHH",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-28",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209019228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "209019228",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ffazil238870@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ffazil238870@direct-ehr-ssmhc.com",
            "address_1": "2 Good Samaritan Way Ste 235",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628642476",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2 Good Samaritan Way Ste 235",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628642476",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "FARIA",
            "last_name": "IMDAD",
            "middle_name": "F",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Nurse Practitioner in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; 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.