Knema Pascal Rezaei-Bazazizad, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

Q3950 Issued in TX

Practice address

1807 W Slaughter LN
Suite 490
Austin, TX 78748-6230

Phone

(512) 282-8967

Fax

(512) 406-7351

NPI assigned

May 29, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Dr. Knema Pascal Rezaei Other name

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: krezaeibazazizad16523@arcmd.direct-ci.com

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.

• Austin Regional Clinic, PA

  • Family Medicine Physician
  • Austin, TX
  • NPI 1821157579

  Pediatrics

  Medicare reassignment NPD
• Austin Regional Clinic, PA

  • Durable Medical Equipment & Medical Supplies
  • Kyle, TX
  • NPI 1235746413
  NPD
• Seton Hospitalist Service

  • Internal Medicine Physician
  • Austin, TX
  • NPI 1013293679
  NPD (past)

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

{
    "created_epoch": "1338249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452556800000",
    "number": "1538429261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4515 SETON CENTER PKWY",
            "address_2": "SUITE 215-CREDENTIALING",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787595290",
            "telephone_number": "512-231-5516",
            "fax_number": "512-406-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 W SLAUGHTER LN",
            "address_2": "SUITE 490",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787486230",
            "telephone_number": "512-282-8967",
            "fax_number": "512-406-7351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZAEI-BAZAZIZAD",
        "first_name": "KNEMA",
        "middle_name": "PASCAL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-29",
        "last_updated": "2016-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "BP10043774",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "Q3950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "351475401",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "351475402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KNEMA",
            "last_name": "REZAEI",
            "middle_name": "PASCAL",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Megan Elizabeth Reynolds, MA, LPC, LMHC, NCC
• Richard Lynn Reynolds, LCSW
• Sarah Rebecca Reynolds, RN
• Tara Reynolds
• Lesly Abigail Reza Olguin
• Aileen Masomian Rezaei, LPC
• Mona Rezapour, DMD
• Heidi Rezendes
• Jane Rha
• Allison Rhea

• Pediatrics Physician in Austin, TX
• Providers in Austin, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.