Abdul Kezin Harris, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

A61120 Issued in CA

Practice address

1701 4TH St
Ste 200
Santa Rosa, CA 95404-3601

Phone

(707) 579-2100

Fax

(707) 523-0616

NPI assigned

Aug 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

General Surgery

Education

University of California, Davis School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Saint Agnes Medical FoundationGroup PAC ID 7618946369, 161 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Agnes Medical Center Hospital, Fresno, CA, CCN 050093

Merit-based Incentive Payment System (MIPS)

Final score

85.57 of 100Reported as group

Quality

63.43

Promoting interoperability

98

Improvement activities

40

Cost

77.49

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: aharris2714568@direct.trinity-health.org

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.

• Saint Agnes Medical Foundation

  • Internal Medicine Physician
  • Fresno, CA
  • NPI 1558819482

  Surgery

  Medicare reassignment Care Compare group NPD
• Surgical Associates Inc

  • Trauma Surgery Physician
  • Modesto, CA
  • NPI 1366824161
  Medicare reassignment
• LQMG Medical Group Inc.

  • Internal Medicine Physician
  • Fresno, CA
  • NPI 1437166360
  NPD
• North Bay Medical Group, Inc.

  • Surgery Physician
  • Santa Rosa, CA
  • NPI 1992716450
  NPD (past)
• Santa Rosa Trauma Physicians Medical Group

  • Trauma Surgery Physician
  • Santa Rosa, CA
  • NPI 1184673162
  NPD (past)
• St. Joseph Health Northern California, LLC

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1134152549
  NPD (past)
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1740413798
  NPD (past)

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

• Saint Agnes Medical Center

  • General Acute Care Hospital
  • Fresno, CA
  • NPI 1205845567
  Care Compare affiliation

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328572800000",
    "number": "1396859393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3536 MENDOCINO AVE",
            "address_2": "STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033634",
            "telephone_number": "707-575-6049",
            "fax_number": "707-523-0616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 4TH ST",
            "address_2": "STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043601",
            "telephone_number": "707-579-2100",
            "fax_number": "707-523-0616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "ABDUL",
        "middle_name": "KEZIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2012-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A61120",
            "primary": true
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "CA",
            "license": "A61120",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00469231",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396859393",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS OF CALIFORNIA",
            "identifier": "00A611200",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nathan Daniel Harper
• Reid Martin Harper
• Christine A Harrington
• Harris and Leibert Group
• Harris R.Young,O.D.
• Alice Marie Harris, FNP
• Daniel Harris
• David Glenn Harris, D.D.S.
• Dawn Erica Harris, PT
• Graceanne Lorraine Harris, CA LMFT

• Surgery Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; 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.
• 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.