Luay D Ailabouni, MD

Key facts

NPI

1114186459

Entity type

Individual (NPI type 1)

Primary specialty

Colon & Rectal Surgery Physician 208C00000X

License

MD30623856 (WA)

Practice address

1100 Goethals Drive, 2ND Floor
Kadlec Clinic General & Colorectal Surgery
Richland, WA 99352-3304

Phone

(509) 942-3185

Fax

(509) 946-1850

NPI assigned

Jun 2, 2008

Sex

Male

Sole proprietor

No

Organizations & group practices 4

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.

• Kadlec Regional Medical Center General Acute Care Hospital · Richland, WA · NPI 1972507580
  Medicare reassignment Care Compare group NPD WA
• Kadlec Regional Medical Center Ambulatory Surgical Clinic/Center · Richland, WA · NPI 1275071789
  Care Compare group
• Kadlec Regional Medical Center Ambulatory Surgical Clinic/Center · Richland, WA · NPI 1861041139
  Care Compare group
• Kadlec Regional Medical Center Rehabilitation Hospital Unit · Richland, WA · NPI 1790319580
  NPD

Hospital & facility affiliations 2

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

• Kadlec Regional Medical Center General Acute Care Hospital · Richland, WA · NPI 1972507580
  Care Compare affiliation Hospital
• Providence Health & Services - Washington General Acute Care Hospital · Walla Walla, WA · NPI 1386895886
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Colorectal Surgery (Proctology)
Also: General Surgery

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kadlec Regional Medical Center (402 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kadlec Regional Medical Center Hospital · Richland, WA · CCN 500058
• Providence St Mary Medical Center Hospital · Walla Walla, WA · CCN 500002

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 5, 2021.

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1114186459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 GAGE BLVD",
            "address_2": "SUITE 203",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993528650",
            "telephone_number": "509-942-3627",
            "fax_number": "509-942-2268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 GOETHALS DRIVE, 2ND FLOOR",
            "address_2": "KADLEC CLINIC GENERAL & COLORECTAL SURGERY",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993523304",
            "telephone_number": "509-942-3185",
            "fax_number": "509-946-1850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "780 Swift Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Richland",
            "state": "WA",
            "postal_code": "993523545",
            "country_code": "US",
            "telephone_number": "509-942-3288",
            "fax_number": "509-946-1850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AILABOUNI",
        "first_name": "LUAY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-02",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD60323856",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "WA",
            "license": "MD30623856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0310710",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500655571",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114186459",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lailabouni1106860@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "780 Swift Blvd Ste 101",
            "city": "Richland",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993523545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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