Advanced Vein & Vascular Associates

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

K0853 Issued in TX

Legal business name

ADVANCED VEIN & VASCULAR ASSOCIATES

Practice address

7515 Greenville Ave Ste 706
Dallas, TX 75231-3885

Phone

(469) 547-1142

Fax

(469) 547-1162

NPI assigned

Sep 7, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Humam Bassam Kakish, M.D.NPI 1730177114

Title

Owner

Phone

(469) 547-1142

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1260

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Humam Bassam Kakish, M.D.

  • Vascular Surgery Physician
  • Dallas, TX
  • NPI 1730177114
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1283817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1497062830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7515 GREENVILLE AVE STE 706",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752313885",
            "telephone_number": "469-547-1142",
            "fax_number": "469-547-1162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7515 GREENVILLE AVE STE 706",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752313885",
            "telephone_number": "469-547-1142",
            "fax_number": "469-547-1162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED VEIN & VASCULAR ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-07",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "KAKISH",
        "authorized_official_first_name": "HUMAM",
        "authorized_official_middle_name": "BASSAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-547-1142",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "TX",
            "license": "K0853",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vascular Surgery Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Vascular Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.