Individual provider Active NPI

Ikha T Al-Azzawi, MD

  • Hospitalist Physician
  • Amarillo, TX
National Provider Identifier
1376006205
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
T4307 Issued in TX
Practice address
1600 Wallace Blvd
Amarillo, TX 79106-1799
Phone
(806) 212-2129
Fax
(806) 212-2246
NPI assigned
Apr 8, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X T4307 TX
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X T4307 TX Primary

Addresses

Primary practice location

1600 Wallace Blvd
Amarillo, TX 79106-1799

Mailing address

1600 Wallace Blvd
Amarillo, TX 79106-1799
Phone (806) 212-2129

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20220714000236 TX Practitioner - HospitalistPractitioner - Family Practice 4981933538 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Family Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bsa Physicians Group IncGroup PAC ID 3971748146, 121 clinicians

Practice addresses (Care Compare)

1600 Wallace Blvd
Amarillo, TX 79106-1799
Phone (806) 212-2129

Hospital & facility affiliations

  • Bsa Compassion Home Care Home health agency, Amarillo, TX, CCN 677943
  • Bsa Hospital Hospital, Amarillo, TX, CCN 450231

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Bsa Physicians Group Inc Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Bsa Physicians Group Inc CurrentSince Jul 1, 2022 Accepting new patients
Bsa Hospital LLC Past Accepting new patients

Locations

1600 Wallace Blvd
Amarillo, TX 79106
Phone (806) 212-2000

1751 Wallace Blvd
Amarillo, TX 79106
Phone (806) 212-2129

Interoperability endpoints

  • Direct secure messaging: ialazzawi263405@ahs.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1376006205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WALLACE BLVD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791061799",
            "telephone_number": "806-212-2129",
            "fax_number": "806-212-2246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 WALLACE BLVD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791061799",
            "telephone_number": "806-212-2129",
            "fax_number": "806-212-2246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL-AZZAWI",
        "first_name": "IKHA",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-08",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "T4307",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "T4307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Amarillo, TX

Sources for this page

Verify at the official NPI Registry.