NPIMap

Individual provider Active NPI

Fakhar Ijaz, MD

  • Nephrology Physician
  • Little Rock, AR
National Provider Identifier
1487653820
Registry record updated Mar 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
E4531 Issued in AR
Practice address
500 S University Ave
Suite 508
Little Rock, AR 72205
Phone
(501) 588-1100
Fax
(501) 588-1750
NPI assigned
Jul 19, 2005
Last updated
Mar 18, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X L5200 TX
Nephrology Physician 207RN0300X E4531 AR Primary

Addresses

Primary practice location

500 S University Ave
Suite 508
Little Rock, AR 72205

Mailing address

500 S University Ave Ste 508
Little Rock, AR 72205-5306
Phone (501) 588-1100

Other identifiers 2

IdentifierTypeStateIssuer
158903001MedicaidAR
1592743-05MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040207000150 TX Practitioner - Internal Medicine 5496648800 Reassigns benefits to 1 organization
I20051209000287 AR Practitioner - NephrologyPractitioner - Internal Medicine 5496648800 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kidney Care Center, PLLCGroup PAC ID 7416048772, 6 clinicians

Practice addresses (Care Compare)

500 S University Ave
Suite 505
Little Rock, AR 72205-5307
Phone (501) 588-1100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L5200TXMDInternal Medicine Physician
E4531ARMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Health and Human Services Commission Current Accepting new patients
Health and Human Services Commission CurrentSince Sep 1, 2017 Accepting new patients
Stuttgart Regional Medical Center Past Accepting new patients
Stuttgart Regional Medical Center Past Accepting new patients
Petit Jean Emergency Physicians Past Accepting new patients
Ramadev LLC Past Accepting new patients
Howard Emergency Medicine Associates PA. Past Accepting new patients
Lydia Inpatient Services Internal Medicine Past Accepting new patients
Big Bend Medical Group Past Accepting new patients

Locations

1901 N US Highway 87
Big Spring, TX 79720
Phone (432) 267-8216

Interoperability endpoints

  • Direct secure messaging: fakhar.ijaz@direct.davitaphysiciansolutions.com

Organizations & group practices 10

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 8

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": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395100800000",
    "number": "1487653820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE STE 508",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055306",
            "telephone_number": "501-588-1100",
            "fax_number": "501-588-1750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE",
            "address_2": "SUITE 508",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72205",
            "telephone_number": "501-588-1100",
            "fax_number": "501-588-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IJAZ",
        "first_name": "FAKHAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2014-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L5200",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AR",
            "license": "E4531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158903001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1592743-05",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.