NPIMap

Individual provider Active NPI

Hisham Alwakkaa

  • Diagnostic Radiology Physician
  • Woodridge, IL
National Provider Identifier
1477089969
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036163665 Issued in IL
Practice address
2521 Cedar Hill LN
Woodridge, IL 60517-4273
Phone
(203) 212-7241
NPI assigned
May 4, 2017
Last updated
Dec 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 70164 CT
Diagnostic Radiology Physician 2085R0202X 036163665 IL Primary
Diagnostic Radiology Physician 2085R0202X 163655 IL

Addresses

Primary practice location

2521 Cedar Hill LN
Woodridge, IL 60517-4273

Mailing address

2521 Cedar Hill LN
Woodridge, IL 60517-4273
Phone (203) 212-7241

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230524003501 IL Practitioner - Diagnostic Radiology 7517218928 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sra Medical Imaging LLCGroup PAC ID 1759369663, 40 clinicians
Riverside Radiology and Interventional Associates IncGroup PAC ID 8729976964, 251 clinicians
Eastpointe Radiologists PCGroup PAC ID 7618876327, 112 clinicians

Practice addresses (Care Compare)

20 Blue Grass CT
Oak Brook, IL 60523-2613
Phone (716) 649-9000

2521 Cedar Hill LN
Woodridge, IL 60517-4273
Phone (716) 649-9000

3857 N Oakley Ave
Chicago, IL 60618-3813
Phone (586) 464-0731

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
163655ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Radiology and Interventional Associates Inc Diagnostic Radiology CurrentSince Apr 1, 2025 Accepting new patients
Southtowns Radiology Associates, LLC Diagnostic Radiology CurrentSince Apr 22, 2024 Accepting new patients
Sra Medical Imaging LLC Diagnostic Radiology CurrentSince Apr 22, 2024 Accepting new patients
Lucidsolutions, Inc. Diagnostic Radiology PastSince Dec 4, 2020 Accepting new patients
Eastpointe Radiologists, PC Diagnostic Radiology Past Accepting new patients

Locations

2157 Main St
Buffalo, NY 14214
Phone (716) 862-1501

Interoperability endpoints

  • Direct secure messaging: halwakkaa1159770@direct.hfhs.org
  • Direct secure messaging: hisham.alwakkaa@xdr.hhchealthdirect.org

Organizations & group practices 6

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.

Hospital & facility affiliations 7

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": "1493856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1477089969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2521 CEDAR HILL LN",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605174273",
            "telephone_number": "203-212-7241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2521 CEDAR HILL LN",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605174273",
            "telephone_number": "203-212-7241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALWAKKAA",
        "first_name": "HISHAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-04",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CT",
            "license": "70164",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036163665",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "163655",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodridge, IL

Sources for this page

Verify at the official NPI Registry.