NPIMap

Organization Active NPI

Pathway Medical Group, Inc.

  • Internal Medicine Physician
  • Anaheim, CA
National Provider Identifier
1407199243
Registry record updated Mar 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PATHWAY MEDICAL GROUP, INC.
Practice address
515 S Beach Blvd
Suite G
Anaheim, CA 92804-1812
Phone
(714) 827-4240
Fax
(714) 827-5785
NPI assigned
Mar 29, 2013
Last updated
Mar 29, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
PATHWAY MEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 29, 2013

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

Authorized official

Name
Hassan M Alkhouli, M.D.
Title
C.E.O.
Phone
(714) 379-3221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X CA Primary

Addresses

Primary practice location

515 S Beach Blvd
Suite G
Anaheim, CA 92804-1812

Mailing address

PO Box 2989
Seal Beach, CA 90740-1989
Phone (714) 379-3221

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041026000511 CA Part B Supplier - Clinic/Group Practice 5092776690 Receives reassigned benefits from 28 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Westminster, CA; Garden Grove, CA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Pathway Medical Group I

Locations

12555 Garden Grove Blvd
Ste 501
Garden Grove, CA 92843
Phone (714) 534-2222

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364515200000",
    "number": "1407199243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2989",
            "city": "SEAL BEACH",
            "state": "CA",
            "postal_code": "907401989",
            "telephone_number": "714-379-3221",
            "fax_number": "714-823-4716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 S BEACH BLVD",
            "address_2": "SUITE G",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928041812",
            "telephone_number": "714-827-4240",
            "fax_number": "714-827-5785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHWAY MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATHWAY MEDICAL GROUP, INC.",
        "enumeration_date": "2013-03-29",
        "last_updated": "2013-03-29",
        "status": "A",
        "authorized_official_last_name": "ALKHOULI",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "714-379-3221",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; 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.