NPIMap

Individual provider Active NPI

Riad Robert Hajjar, M.D.

  • Internal Medicine Physician
  • Port Huron, MI
National Provider Identifier
1538153176
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
RH066725 Issued in MI
Practice address
1201 Stone St
Ste. 5
Port Huron, MI 48060-3563
Phone
(810) 966-9556
Fax
(810) 966-4898
NPI assigned
Sep 9, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X RH066725 MI Primary

Addresses

Primary practice location

1201 Stone St
Ste. 5
Port Huron, MI 48060-3563

Mailing address

1201 Stone St
Ste. 5
Port Huron, MI 48060-3563
Phone (810) 966-9556

Other identifiers 1

IdentifierTypeStateIssuer
127697MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050920000482 MI Practitioner - Internal Medicine 2264466275 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1201 Stone St
Port Huron, MI 48060-3563
Phone (810) 966-9556

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RH066725MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
R S Balboa MDPC Internal Medicine Current Accepting new patients
Riad R. Hajjar MD PC Internal Medicine CurrentSince Oct 1, 2005 Accepting new patients
McLaren Port Huron Past Accepting new patients
Prime Healthcare Services-Port Huron LLC Past Accepting new patients

Locations

1201 Stone St
Ste 5
Port Huron, MI 48060
Phone (810) 966-9556

Organizations & group practices 4

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 7

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": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538153176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 STONE ST",
            "address_2": "STE. 5",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603563",
            "telephone_number": "810-966-9556",
            "fax_number": "810-966-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 STONE ST",
            "address_2": "STE. 5",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603563",
            "telephone_number": "810-966-9556",
            "fax_number": "810-966-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAJJAR",
        "first_name": "RIAD",
        "middle_name": "ROBERT",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "RH066725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127697",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

Verify at the official NPI Registry.