Individual provider Active NPI

Haitham Al-Wahab, MD

  • Pediatric Critical Care Medicine Physician
  • Houston, TX
National Provider Identifier
1225370331
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
R9462 Issued in TX
Practice address
6431 Fannin St
Houston, TX 77030-1501
Phone
(713) 500-6016
NPI assigned
Mar 27, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X R9264 TX
Pediatric Critical Care Medicine Physician 2080P0203X R9462 TX Primary

Addresses

Primary practice location

6431 Fannin St
Houston, TX 77030-1501

Mailing address

6431 Fannin St
Suite MSB 3.228
Houston, TX 77030-1501
Phone (713) 500-5650

Other identifiers 1

IdentifierTypeStateIssuer
395130303MedicaidTX

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20200514001819 TX Practitioner - Pediatric MedicinePractitioner - Critical Care (Intensivists) 3577994136 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R9264TXMDFamily Medicine Physician
R9462TXMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Physicians CurrentSince Jul 1, 2020 Accepting new patients
Ut Physicians Pediatrics CurrentSince Jul 1, 2020 Accepting new patients
Memorial Hermann Health System Past Accepting new patients

Locations

6410 Fannin St
Ste 500
Houston, TX 77030
Phone (713) 500-5714

6431 Fannin St
Ste Msb
Houston, TX 77030
Phone (713) 500-5800

6431 Fannin St
Houston, TX 77030
Phone (713) 500-5800

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1225370331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6431 FANNIN ST",
            "address_2": "SUITE MSB 3.228",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501",
            "telephone_number": "713-500-5650",
            "fax_number": "713-500-0588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6431 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501",
            "telephone_number": "713-500-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL-WAHAB",
        "first_name": "HAITHAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-27",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "R9264",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "TX",
            "license": "R9462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "395130303",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.