Ida Fazakas, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN2366571 Issued in MA

Practice address

108 Merrimack St
Haverhill, MA 01830-5210

Phone

(833) 510-4357

NPI assigned

Jul 5, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NH, MA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Vantage Healthcare LLC

  dba Vantage Healthcare

  • Internal Medicine Physician
  • Canton, MA
  • NPI 1366903551

  NH

  Medicare reassignment NPD
• Centers for Pain Solutions,LLC

  • Ambulatory Surgical Clinic/Center
  • Nashua, NH
  • NPI 1508934373
  NPD (past)
• Countryside Medical SC

  • Specialist
  • Countryside, IL
  • NPI 1366726283
  NPD (past)
• Countryview Medical Center SC

  • Chiropractor
  • Countryside, IL
  • NPI 1285695544
  NPD (past)
• Illinois Back and Joint PLLC

  dba Illinois Back Institute

  • Sports Medicine (Family Medicine) Physician
  • Orland Park, IL
  • NPI 1750985214
  NPD (past)

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

{
    "created_epoch": "1372982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1285074278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MONTGOMERY RD STE 400",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452122600",
            "telephone_number": "513-873-1269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 MERRIMACK ST",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018305210",
            "telephone_number": "833-510-4357"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "458 Old Street Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Peterborough",
            "state": "NH",
            "postal_code": "034581265",
            "country_code": "US",
            "telephone_number": "603-924-2144",
            "fax_number": "603-924-3993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAZAKAS",
        "first_name": "IDA",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-05",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2366571",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NH",
            "license": "071464-23",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Dental Associates LLC (Family Dental Associates)
• Andrea Faria
• Tanya Lynne Farrar
• Lily Farrell
• Leigh Faulkner, LMHC
• Andrea Kara Fazio, PHARM D
• Kerry Fenlon, LICSW
• Ferlito Orthodontics PLLC
• Lilliana Fermin, IHT CLINICIAN
• Elizabeth Ferrara

• Nurse Practitioner in Haverhill, MA
• Providers in Haverhill, MA by specialty
• Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; 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.