NPIMap

Organization Active NPI

Pathway Medical Group, Inc

  • Family Medicine Physician
  • Garden Grove, CA
National Provider Identifier
1184670762
Registry record updated May 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PATHWAY MEDICAL GROUP, INC
Practice address
12665 Garden Grove Blvd
#502-A
Garden Grove, CA 92843-1901
Phone
(714) 537-7800
Fax
(714) 537-7633
NPI assigned
May 26, 2006
Last updated
May 6, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
PATHWAY MEDICAL GROUP, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 6, 2008

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

Authorized official

Name
Dr. Hassan M. Alkhouli, M.D.
Title
C.E.O.
Phone
(714) 379-3221

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Critical Care Medicine (Internal Medicine) Physician 207RC0200X NU
Pulmonary Disease Physician 207RP1001X NU

Addresses

Primary practice location

12665 Garden Grove Blvd
#502-A
Garden Grove, CA 92843-1901

Mailing address

PO Box 2989
Seal Beach, CA 90740-1989
Phone (714) 379-3221

Other identifiers 2

IdentifierTypeStateIssuer
GR0100562MedicaidCA
GR0100560MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041026000511 CA Part B Supplier - Clinic/Group Practice 5092776690 Receives reassigned benefits from 28 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Westminster, CA; Garden Grove, CA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Pathway Medical Group I

Locations

12665 Garden Grove Blvd
Ste 502A
Garden Grove, CA 92843
Phone (714) 534-3900

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210032000000",
    "number": "1184670762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2989",
            "city": "SEAL BEACH",
            "state": "CA",
            "postal_code": "907401989",
            "telephone_number": "714-379-3221",
            "fax_number": "714-379-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD",
            "address_2": "#502-A",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431901",
            "telephone_number": "714-537-7800",
            "fax_number": "714-537-7633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHWAY MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATHWAY MEDICAL GROUP, INC",
        "enumeration_date": "2006-05-26",
        "last_updated": "2008-05-06",
        "status": "A",
        "authorized_official_last_name": "ALKHOULI",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "714-379-3221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0100562",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0100560",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.