Wisam Fawzi Shaba, M.D

Primary specialty

Nuclear Medicine PhysicianTaxonomy code 207U00000X

License

50677 Issued in AZ

Practice address

14775 W Yorkshire Dr
Surprise, AZ 85374-7224

Phone

(623) 594-5050

NPI assigned

Jan 10, 2012

Last updated

Mar 30, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, WA2 enrollments

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 2

Specialty

Nuclear Medicine

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alante Primary Care W LLCGroup PAC ID 7517487432, 4 clinicians

Z Medicine LLCGroup PAC ID 8426445891, 12 clinicians

Alante Primary Care and Palliative Services LLCGroup PAC ID 4183016769, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aleca Home Health Home health agency, Scottsdale, AZ, CCN 037271
• Aleca Home Health Home health agency, Silverdale, WA, CCN 507134
• Aleca Hospice Hospice, Scottsdale, AZ, CCN 031670
• Sante Of Surprise Nursing home, Surprise, AZ, CCN 035282
• Sante of Mesa Nursing home, Mesa, AZ, CCN 035280

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Asante of Mesa, LLC

  dba Sante of Mesa

  • Skilled Nursing Facility
  • Mesa, AZ
  • NPI 1407152812

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Sante Hospice, LLC

  • Community Based Hospice Care Agency
  • Scottsdale, AZ
  • NPI 1639559982

  W-2 Managing Employee

  CMS ownership

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.

• Z Medicine LLC

  • Hospitalist Physician
  • Surprise, AZ
  • NPI 1073253712
  Medicare reassignment Care Compare group NPD Authorized official
• Alante Primary Care and Palliative Services LLC

  dba Alante Primary Care LLC

  • Primary Care Clinic/Center
  • Scottsdale, AZ
  • NPI 1700468527
  Medicare reassignment Care Compare group NPD
• Alante Primary Care W LLC

  • Primary Care Clinic/Center
  • Scottsdale, AZ
  • NPI 1568279792

  WA

  Medicare reassignment Care Compare group NPD
• Advanced Medical Care LLC

  • Internal Medicine Physician
  • Scottsdale, AZ
  • NPI 1285888271
  Medicare reassignment NPD
• Scottsdale Physicians Group PLC

  • Internal Medicine Physician
  • Scottsdale, AZ
  • NPI 1689799579
  Medicare reassignment NPD
• Encore Home Health, LLC

  • Home Health Agency
  • Silverdale, WA
  • NPI 1902369606

  Cardiovascular Disease

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Asante of Mesa, LLC

  dba Sante of Mesa

  • Skilled Nursing Facility
  • Mesa, AZ
  • NPI 1407152812

  Nursing home

  Care Compare affiliation
• Asante TRC of Surprise LLC

  dba Sante of Surprise

  • Skilled Nursing Facility
  • Surprise, AZ
  • NPI 1992096101

  Nursing home

  Care Compare affiliation
• Focus Home Therapy & Medical Services, LLC

  dba Aleca Home Health

  • Home Health Agency
  • Scottsdale, AZ
  • NPI 1629217278
  Care Compare affiliation
• Focus Home Therapy & Medical Services, LLC

  dba Aleca Home Health

  • Home Health Agency
  • Peoria, AZ
  • NPI 1871048025
  Care Compare affiliation
• Sante Hospice, LLC

  • Community Based Hospice Care Agency
  • Scottsdale, AZ
  • NPI 1639559982
  Care Compare affiliation
• Encore Home Health, LLC

  • Home Health Agency
  • Silverdale, WA
  • NPI 1902369606
  Care Compare affiliation

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

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1366712176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11773",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852480013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14775 W YORKSHIRE DR",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853747224",
            "telephone_number": "623-594-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHABA",
        "first_name": "WISAM",
        "middle_name": "FAWZI",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-10",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "CA",
            "license": "A117646",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A117646",
            "primary": false
        },
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "AZ",
            "license": "50677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serenity Preferred LLC
• Leonardo C Serfino, MD
• Amy Kathleen Serkland, RN, BSN
• John Joseph Sesta, DDS
• Theresa Marie Seward, MA, LPC
• Kathleen Nicole Shafer, PT, DPT
• Dawn Shagena
• Masih Shahlaie, B.D.S., M.S.
• Aaron David Shamblin, OTR L
• Elizabeth Shamon, OTD, OTR/L

• Nuclear Medicine Physician in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Nuclear Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• 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.