Individual provider Active NPI

Rommie Fawzi Fakhoury, MD

  • Family Medicine Physician
  • Rancho Cucamonga, CA
National Provider Identifier
1528000643
Registry record updated Sep 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A89167 Issued in CA
Practice address
10601 Church Street Ste 110
Rancho Cucamonga, CA 91730
Phone
(909) 989-7100
Fax
(909) 989-6333
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 13, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A89167 CA Primary

Addresses

Primary practice location

10601 Church Street Ste 110
Rancho Cucamonga, CA 91730

Mailing address

P.O. Box 872
Alta Loma, CA 91701
Phone (909) 989-7100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121101000619 CA Practitioner - Family Practice 1052569274 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

10601 Church St
Suite 105
Rancho Cucamonga, CA 91730-6894
Phone (909) 989-7100

Hospital & facility affiliations

  • San Antonio Regional Hospital Hospital, Upland, CA, CCN 050099

Merit-based Incentive Payment System (MIPS)

Final score
67.01 of 100Reported as individual
Quality
33.94
Improvement activities
40
Cost
78.1

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions14
Skin biopsy24

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
89167CAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rommie F. Fakhoury MD Inc Family Medicine CurrentSince Dec 24, 2007 Accepting new patients
Summit Medical Center Past Accepting new patients
Rommie Fakhoury, M.D. Inc. Family Medicine Past Accepting new patients

Locations

10601 Church St
Ste 110
Rch Cucamonga, CA 91730
Phone (909) 987-1282

10601 Church St
Ste 105
Rch Cucamonga, CA 91730
Phone (909) 989-7100

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505260800000",
    "number": "1528000643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 872",
            "city": "ALTA LOMA",
            "state": "CA",
            "postal_code": "91701",
            "telephone_number": "909-989-7100",
            "fax_number": "909-989-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10601 CHURCH STREET STE 110",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "91730",
            "telephone_number": "909-989-7100",
            "fax_number": "909-989-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAKHOURY",
        "first_name": "ROMMIE",
        "middle_name": "FAWZI",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2017-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A89167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.