Basil M Fathalla, M.D.

Primary specialty

Pediatric Rheumatology PhysicianTaxonomy code 2080P0216X

License

MD427787 Issued in PA

Practice address

3901 Beaubien St
Children'S Hospital of Mi
Detroit, MI 48201-2119

Phone

(215) 427-5094

NPI assigned

Jun 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• University Pediatricians

  • Pediatrics Physician
  • Detroit, MI
  • NPI 1811920549
  Medicare reassignment NPD
• University Pediatricians

  • Pediatrics Physician
  • Detroit, MI
  • NPI 1184471690
  NPD

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243468800000",
    "number": "1205879954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 ST. ANTOINE",
            "address_2": "UNIVERSITY PEDIATRICIANS UHC 6F MAILBOX# 226",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482014139",
            "telephone_number": "313-966-5051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 BEAUBIEN ST",
            "address_2": "CHILDREN'S HOSPITAL OF MI",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012119",
            "telephone_number": "215-427-5094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATHALLA",
        "first_name": "BASIL",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2009-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0216X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Rheumatology",
            "state": "PA",
            "license": "MD427787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1014672880001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sebastian Bach Fastrich, LCSW, LMSW, ICADC
• Rebecca Jean Faszcza, MSW
• Terri Fata, RDH
• Malak Fatahi
• Ghadeer Fatani, MD
• Lamia Fathallah, MD
• Fathers, Mothers and Infants, LLC
• Amanah Sana Fatima, DO
• Haseen Fatima
• Juveria Fatima, MD

• Pediatric Rheumatology Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Pediatric Rheumatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2009; 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.

Verify at the official NPI Registry.