Active NPI
Farihah Azam
- Physician Assistant
- Kennesaw, GA
National Provider Identifier
1508499203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 11123
- Practice address
- 1977 Westover LN NW
Kennesaw, GA 30152-4255 - Phone
- (678) 949-2742
- NPI assigned
- Feb 20, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | |||
| Physician Assistant | 363A00000X | 11123 | GA | Primary |
Addresses
Primary practice location
1977 Westover LN NW
Kennesaw, GA 30152-4255
Mailing address
1977 Westover LN NW
Kennesaw, GA 30152-4255
Phone (678) 949-2742
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA, VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3540 Cobb Pkwy NW
Acworth, GA 30101-4178
Phone (770) 974-3911
3827 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2804
Phone (770) 222-8900
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.51 of 100
- Quality
- 80.61
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11123 | GA | MD | Physician Assistant |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Hiram, GA
- NPI 1437194156
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699315200000",
"number": "1508499203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1977 WESTOVER LN NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301524255",
"telephone_number": "678-949-2742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1977 WESTOVER LN NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301524255",
"telephone_number": "678-949-2742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AZAM",
"first_name": "FARIHAH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-02-20",
"last_updated": "2023-11-07",
"certification_date": "2023-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "11123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.