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Individual provider Active NPI

Hazam Mansour Ademhizam, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Buena Park, CA
National Provider Identifier
1073645131
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA 19085 Issued in CA
Practice address
6744 Knott Ave Apt 4
Buena Park, CA 90621-2736
Phone
(714) 228-0715
NPI assigned
Mar 12, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA 19085 CA Primary

Addresses

Primary practice location

6744 Knott Ave Apt 4
Buena Park, CA 90621-2736

Mailing address

6744 Knott Ave Apt 4
Buena Park, CA 90621-2736
Phone (714) 228-0715

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20161215000297 TX Practitioner - Physician Assistant 4880789718 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dallas County Hospital DistrictGroup PAC ID 8325934813, 597 clinicians

Practice addresses (Care Compare)

1800 N Britain Rd
Parkland Health
Irving, TX 75061-2630
Phone (214) 266-3000

5200 Harry Hines Blvd
Dallas, TX 75235-7709
Phone (214) 590-8006

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.1 of 100Reported as group
Quality
88.97
Promoting interoperability
79
Improvement activities
40
Cost
83.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts, Physician Assistant

State licenses

LicenseStateTypeSpecialty
19085CAMDSpeech-Language Pathologist
PA 19085CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dallas County Hospital District CurrentSince Jun 4, 2021 Accepting new patients
Dallas County Hospital District Physician Assistant CurrentSince Jun 4, 2021 Accepting new patients
HCN Ep Horizon City, LLC Past Accepting new patients

Locations

1800 N Britain Rd
Irving, TX 75061
Phone (214) 266-3000

Organizations & group practices 7

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 44

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

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073645131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6744 KNOTT AVE APT 4",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906212736",
            "telephone_number": "714-228-0715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6744 KNOTT AVE APT 4",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906212736",
            "telephone_number": "714-228-0715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEMHIZAM",
        "first_name": "HAZAM",
        "middle_name": "MANSOUR",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 19085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buena Park, CA

Sources for this page

Verify at the official NPI Registry.