NPIMap

Individual provider Active NPI

Alan Awdisho, D.O.

  • Internal Medicine Physician
  • El Cajon, CA
National Provider Identifier
1164795498
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
006688 Issued in AZ
Practice address
875 El Cajon Blvd
El Cajon, CA 92020-5714
Phone
(619) 662-4100
NPI assigned
Feb 16, 2012
Last updated
Mar 23, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 006688 AZ Primary

Addresses

Primary practice location

875 El Cajon Blvd
El Cajon, CA 92020-5714

Mailing address

1601 Precision Park LN
San Diego, CA 92173-1345
Phone (619) 662-4100

Other practice location 1

3115 S Price Rd
Chandler, AZ 85248-3544
Phone (888) 488-7640

Other practice location 2

13677 W McDowell Rd
Goodyear, AZ 85395-2635
Phone (623) 882-1672

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150724010366 AZ Practitioner - HospitalistPractitioner - Internal MedicinePractitioner - Infectious Disease 0244543841 Reassigns benefits to 1 organization
I20220125000694 CA Practitioner - Internal Medicine 0244543841 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Infectious Disease
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospitalist Medicine Healthcare LLCGroup PAC ID 5193948867, 13 clinicians

Practice addresses (Care Compare)

2200 E Show Low Lake Rd
Show Low, AZ 85901-7831
Phone (302) 354-5471

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
006688AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc CurrentSince Jan 10, 2022 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Jan 10, 2022 Accepting new patients
Summit Healthcare Association Past Accepting new patients

Locations

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

875 El Cajon Blvd
El Cajon, CA 92020
Phone (619) 205-4585

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

1601 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 205-4585

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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 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": "1329350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1164795498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 PRECISION PARK LN",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921731345",
            "telephone_number": "619-662-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 EL CAJON BLVD",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920205714",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3115 S Price Rd",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852483544",
            "country_code": "US",
            "telephone_number": "888-488-7640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13677 W McDowell Rd",
            "address_purpose": "LOCATION",
            "city": "Goodyear",
            "state": "AZ",
            "postal_code": "853952635",
            "country_code": "US",
            "telephone_number": "623-882-1672",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AWDISHO",
        "first_name": "ALAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-16",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "006688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Cajon, CA

Sources for this page

Verify at the official NPI Registry.