Individual provider Active NPI

Habib Ahmad Haidary, MD

  • Family Medicine Physician
  • West Covina, CA
National Provider Identifier
1124657580
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A182110 Issued in CA
Practice address
1115 S Sunset Ave
West Covina, CA 91790-3940
Phone
(626) 813-7837
NPI assigned
Apr 7, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X A182110 CA
Family Medicine Physician 207Q00000X A182110 CA Primary

Addresses

Primary practice location

1115 S Sunset Ave
West Covina, CA 91790-3940

Mailing address

1115 S Sunset Ave
West Covina, CA 91790-3940

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230809003352 CA Practitioner - Family Practice 7911369855 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Galen Inpatient Physicians PCGroup PAC ID 3678464633, 1,045 clinicians
Southern California Hospitalist Network Medical Group IncGroup PAC ID 8921990110, 76 clinicians

Practice addresses (Care Compare)

1115 S Sunset Ave
West Covina, CA 91790-3940
Phone (626) 962-4011

625 The City Dr S
Suite 320
Orange, CA 92868-4978
Phone (714) 202-2330

Hospital & facility affiliations

  • Emanate Health Inter-Community Hospital Hospital, Covina, CA, CCN 050382

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A182110CAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Hospitalist Network Medical Group Inc CurrentSince Aug 1, 2023 Accepting new patients
Galen Inpatient Physicians PC Hospitalist CurrentSince Feb 1, 2026 Accepting new patients
Galen Inpatient Physicians, PC Hospitalist CurrentSince Feb 1, 2026 Accepting new patients

Locations

1509 Wilson Ter
Glendale, CA 91206
Phone (818) 409-8071

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

625 The City Dr S
Ste 320
Orange, CA 92868
Phone (714) 202-2330

1115 S Sunset Ave
West Covina, CA 91790
Phone (626) 814-2434

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1124657580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 S SUNSET AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 S SUNSET AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903940",
            "telephone_number": "626-813-7837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAIDARY",
        "first_name": "HABIB",
        "middle_name": "AHMAD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-07",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A182110",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A182110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Covina, CA

Sources for this page

Verify at the official NPI Registry.