Arizona Endocrinology & Diabetes Clinic Inc

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

41644 Issued in AZ

Legal business name

ARIZONA ENDOCRINOLOGY & DIABETES CLINIC INC

Practice address

18301 N 79TH Ave Ste C136
Glendale, AZ 85308-8471

Phone

(623) 466-3890

NPI assigned

Jan 21, 2018

Organization subpart

No

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

Authorized official

Name

Abdullah Hanna-Moussa, MDNPI 1194735456

Title

Owner

Phone

(623) 466-3890

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Arizona Endocrinology & Diabetes Clinic Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Abdullah Hanna-Moussa, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Peoria, AZ
  • NPI 1194735456
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1516492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516492800000",
    "number": "1346758653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18301 N 79TH AVE STE C136",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088471",
            "telephone_number": "623-466-3890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18301 N 79TH AVE STE C136",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088471",
            "telephone_number": "623-466-3890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA ENDOCRINOLOGY & DIABETES CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-21",
        "last_updated": "2018-01-21",
        "status": "A",
        "authorized_official_last_name": "HANNA-MOUSSA",
        "authorized_official_first_name": "ABDULLAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-466-3890",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "AZ",
            "license": "41644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "451541",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arizona Endocrinology & Diabetes Clinic Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Endocrinology, Diabetes & Metabolism Physician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Endocrinology, Diabetes & Metabolism Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.