Organization Active NPI

I Henawi MD Inc

  • General Practice Physician
  • Hemet, CA
National Provider Identifier
1144557539
Registry record updated Jun 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A62143 Issued in CA
Legal business name
I HENAWI MD INC
Practice address
4020 W Florida Ave
Hemet, CA 92545-5279
Phone
(951) 765-5000
Fax
(951) 658-0237
NPI assigned
Nov 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2010

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

Authorized official

Name
Dr. I Henawi, M.D.
Title
Owner
Phone
(951) 765-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X A62143 CA Primary

Addresses

Primary practice location

4020 W Florida Ave
Hemet, CA 92545-5279

Mailing address

4020 W Florida Ave
Hemet, CA 92545-5279
Phone (951) 765-5000

Other identifiers 2

IdentifierTypeStateIssuer
1144557539MedicaidCA
CS602AOtherCAPROVIDER NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100209000618 CA Part B Supplier - Clinic/Group Practice 4789727090 Receives reassigned benefits from 1 practitioner
Practice locations: Hemet, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2002896I Henawi, MD Inc4020 West Florida Avenue, Hemet, CA 92545Certificate of waiverJan 27, 2028

National Provider Directory

National Provider Directory

Locations

4020 W Florida Ave
Ste 8
Hemet, CA 92545

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": "1257465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276214400000",
    "number": "1144557539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 W FLORIDA AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925455279",
            "telephone_number": "951-765-5000",
            "fax_number": "951-658-0237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 W FLORIDA AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925455279",
            "telephone_number": "951-765-5000",
            "fax_number": "951-658-0237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I HENAWI MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-06",
        "last_updated": "2010-06-11",
        "status": "A",
        "authorized_official_last_name": "HENAWI",
        "authorized_official_first_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-765-5000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A62143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144557539",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "CS602A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hemet, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.