Hazem Tabbaa, D.O

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

02005812A Issued in IN

Practice address

11050 Parkview Circle Dr
Fort Wayne, IN 46845-1739

Phone

(833) 724-8326

NPI assigned

Mar 17, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Gastroenterology

Education

Philadelphia College of Osteopathic Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Memorial HospitalGroup PAC ID 8527976497, 210 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Healthcare Hospital, Owosso, MI, CCN 230121

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: h.tabbaa@memorialhealthcare.midirect.net

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Memorial Hospital

  • General Acute Care Hospital
  • Owosso, MI
  • NPI 1063414233

  Corporate Director

  CMS ownership
• Memorial Hospital

  • Skilled Nursing Facility
  • Owosso, MI
  • NPI 1114014321

  Corporate Director

  CMS ownership
• Memorial Hospital

  • Community Based Hospice Care Agency
  • Owosso, MI
  • NPI 1396832507

  Corporate Director

  CMS ownership
• Memorial Hospital

  • Home Health Agency
  • Owosso, MI
  • NPI 1952498610

  Corporate Director

  CMS ownership

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.

• Memorial Hospital

  • General Practice Physician
  • Owosso, MI
  • NPI 1235160532

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Memorial Hospital

  • General Practice Physician
  • Owosso, MI
  • NPI 1316008006
  NPD
• Memorial Hospital

  • Anesthesiology Physician
  • Owosso, MI
  • NPI 1659527737
  NPD
• Memorial Hospital

  • Home Health Agency
  • Owosso, MI
  • NPI 1952498610
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Memorial Hospital

  • General Acute Care Hospital
  • Owosso, MI
  • NPI 1063414233
  Care Compare affiliation

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

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1619393477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 NEW VISION DR BLDG B",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451703",
            "telephone_number": "260-266-6013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 PARKVIEW CIRCLE DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451739",
            "telephone_number": "833-724-8326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 MacArthur Blvd",
            "address_purpose": "LOCATION",
            "city": "Munster",
            "state": "IN",
            "postal_code": "463212901",
            "country_code": "US",
            "telephone_number": "219-836-1600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4321 Fir St",
            "address_purpose": "LOCATION",
            "city": "East Chicago",
            "state": "IN",
            "postal_code": "463123049",
            "country_code": "US",
            "telephone_number": "219-392-1700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2720 S Highland Ave Apt 763",
            "address_purpose": "LOCATION",
            "city": "Lombard",
            "state": "IL",
            "postal_code": "601487156",
            "country_code": "US",
            "telephone_number": "586-854-2671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TABBAA",
        "first_name": "HAZEM",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-17",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "02005812A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300034150",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ellen Szwed, D.O.
• Margaret Kerwin Szymanski
• Jenna A. Szymialis, AU.D.
• T Love Home Care Services, LLC
• T-Med Services, Inc
• Hope Tabor
• Lakesha D Tabron, PMHNP
• Mary Tackett
• Brienne Tadeo
• Ahmad Taftaf

• Internal Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.

Verify at the official NPI Registry.