NPIMap

Individual provider Active NPI

Basil H Hazimah, DPM

  • Foot & Ankle Surgery Podiatrist
  • Carbondale, IL
National Provider Identifier
1306903851
Registry record updated Sep 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
0160053701 Issued in IL
Practice address
1235 Cedar CT
Carbondale, IL 62901-5335
Phone
(618) 457-0431
Fax
(618) 457-5199
NPI assigned
Jan 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 36003066H OH
Foot & Ankle Surgery Podiatrist 213ES0103X 0160053701 IL Primary

Addresses

Primary practice location

1235 Cedar CT
Carbondale, IL 62901-5335

Mailing address

PO Box 997
Carbondale, IL 62903-0997
Phone (618) 457-0431

Other identifiers 3

IdentifierTypeStateIssuer
016005370MedicaidIL
CI5845OtherILRAILROAD MEDICARE
03922239OtherILBLUE CROSS/BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0160053701ILMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Foot and Ankle Clinic LTD Past Accepting new patients
Pro-Active Wound Care Clinics LLC Foot & Ankle Surgery Past Accepting new patients
Basil H Hazimah, DPM, Inc Foot & Ankle Surgery Past Accepting new patients
The Foot & Ankle Health Center Foot & Ankle Surgery Past Accepting new patients

Organizations & group practices 4

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": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221523200000",
    "number": "1306903851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 997",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629030997",
            "telephone_number": "618-457-0431",
            "fax_number": "618-457-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 CEDAR CT",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015335",
            "telephone_number": "618-457-0431",
            "fax_number": "618-457-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZIMAH",
        "first_name": "BASIL",
        "middle_name": "H",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2008-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OH",
            "license": "36003066H",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "0160053701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016005370",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI5845",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "03922239",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.