Active NPI
Mohamad Bassam Abaza, M.D.
- Pediatrics Physician
- Oregon, OH
National Provider Identifier
1184621963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 35100330
- Practice address
- 3156 Dustin Rd
Suite 203
Oregon, OH 43616-4342 - Phone
- (419) 698-1514
- Fax
- (419) 698-3827
- NPI assigned
- Jul 7, 2005
- Last updated
- Oct 30, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35100330 | OH | Primary |
Addresses
Primary practice location
3156 Dustin Rd
Suite 203
Oregon, OH 43616-4342
Mailing address
3156 Dustin Rd
Suite 203
Oregon, OH 43616-4342
Phone (419) 698-1514
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000211829 | Other | OH | ANTHEM |
| 0277990 | Medicaid | OH | |
| 00002 | Other | OH | PARAMOUNT |
| 12-01435 | Other | OH | UHC |
| 0633278 | Other | OH | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131120001217 | OH | Order and Referring Only - Pediatric Medicine | 2860563335 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383091200000",
"number": "1184621963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3156 DUSTIN RD",
"address_2": "SUITE 203",
"city": "OREGON",
"state": "OH",
"postal_code": "436164342",
"telephone_number": "419-698-1514",
"fax_number": "419-698-3827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3156 DUSTIN RD",
"address_2": "SUITE 203",
"city": "OREGON",
"state": "OH",
"postal_code": "436164342",
"telephone_number": "419-698-1514",
"fax_number": "419-698-3827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABAZA",
"first_name": "MOHAMAD",
"middle_name": "BASSAM",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-07",
"last_updated": "2013-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35100330",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000211829",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0277990",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARAMOUNT",
"identifier": "00002",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "12-01435",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0633278",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oregon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.