Individual provider Active NPI

Sebah Abdulaziz

  • Anesthesiologist Assistant
  • Fort Wayne, IN
National Provider Identifier
1245726645
Registry record updated Oct 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
75000034A Issued in IN
Practice address
11141 Parkview Plaza Dr Ste 200
Fort Wayne, IN 46845-1714
Phone
(260) 425-6030
Fax
(260) 425-6028
NPI assigned
Jul 9, 2018
Last updated
Oct 25, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 75000034A IN Primary

Addresses

Primary practice location

11141 Parkview Plaza Dr Ste 200
Fort Wayne, IN 46845-1714

Mailing address

3702 New Vision Dr BLDG B
Fort Wayne, IN 46845-1703

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210119000921 GA Practitioner - Anesthesiology Assistant 7618211210 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Nova Southeastern College of Osteo Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

1120 15TH St
Augusta, GA 30912-0004
Phone (706) 721-8623

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

989 Saint Sebastian Way
Augusta, GA 30912-0004
Phone (706) 721-2171

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.48 of 100Reported as group
Quality
87.56
Promoting interoperability
100
Improvement activities
40
Cost
75.14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
10045GAMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Grady Memorial Hospital Corporation CurrentSince Mar 1, 2023 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Aug 1, 2025 Accepting new patients
Grady Memorial Hospital Corporation CurrentSince Mar 1, 2023 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Mak Anesthesia Georgia, LLC CurrentSince Oct 10, 2023 Accepting new patients
Mak Anesthesia Holdings LLC CurrentSince Nov 1, 2020 Accepting new patients

Locations

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

895 Canton Rd NE
Bldg 200
Marietta, GA 30060
Phone (678) 784-0203

4441 Atlanta Rd SE
Smyrna, GA 30080
Phone 7707021806 ext. 210

2131 Fountain Dr
Snellville, GA 30078
Phone (770) 979-8200

Organizations & group practices 6

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 1

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": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540425600000",
    "number": "1245726645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 NEW VISION DR BLDG B",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11141 PARKVIEW PLAZA DR STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451714",
            "telephone_number": "260-425-6030",
            "fax_number": "260-425-6028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDULAZIZ",
        "first_name": "SEBAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2018-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "IN",
            "license": "75000034A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.