Hisham Alwakkaa
Individual provider Active NPI Diagnostic Radiology Physician · Woodridge, IL
NPI 1477089969 · NPPES record last updated Dec 28, 2023
Key facts
- NPI
- 1477089969
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 036163665 (IL)
- Practice address
- 2521 Cedar Hill LN
Woodridge, IL 60517-4273 - Phone
- (203) 212-7241
- NPI assigned
- May 4, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sra Medical Imaging LLC
Riverside Radiology and Interventional Associates Inc
Eastpointe Radiologists PC
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
- Henry Ford Health Warren Hospital
- Henry Ford Health St John Hospital
- Mercy Hospital of Buffalo
- Sisters of Charity Hospital
- Marietta Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230524003501 | IL | Practitioner - Diagnostic Radiology | 7517218928 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036163665 | IL | MD | Diagnostic Radiology Physician |
| 163655 | IL | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverside Radiology and Interventional Associates Inc | Diagnostic Radiology | Current |
Accepting new patients |
| Sra Medical Imaging LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Southtowns Radiology Associates, LLC | Diagnostic Radiology | Current |
Accepting new patients |
| Lucidsolutions, Inc. | Diagnostic Radiology | Past |
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
- hisham.alwakkaa@xdr.hhchealthdirect.org
- halwakkaa1159770@direct.hfhs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 70164 | CT | |
| Diagnostic Radiology Physician | 2085R0202X | 036163665 | IL | Yes |
| 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
Other providers in Woodridge, IL
- Nancy Allard
- Alldental PC
- Patrick Allen
- Susana Almaraz
- Neelam Ashutosh Aloor
- Evelyn Amaro
- American Drug Stores LLC
- Amerita, Inc.
- Andrea Andersen
- Dwayne Anderson
All providers in Woodridge, IL · Diagnostic Radiology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.