Jack Fatiha, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

229099 Issued in NY

Practice address

709 Avenue U
Brooklyn, NY 11223-4133

Phone

(718) 336-0100

Fax

(718) 336-7139

NPI assigned

Aug 19, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Internal Medicine

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EBDJBA/Endpoint/EBDJBA
• Direct secure messaging: jackfatiha@mai.allscriptsdirect.net

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.

• Jack Fatiha MD PC

  • Health Service Clinic/Center
  • Brooklyn, NY
  • NPI 1770596975
  Medicare reassignment NPD Authorized official
• Maimonides Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1093777492
  NPD

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207872000000",
    "number": "1619969177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 AVENUE U",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112234133",
            "telephone_number": "718-336-0100",
            "fax_number": "718-336-7139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 AVENUE U",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112234133",
            "telephone_number": "718-336-0100",
            "fax_number": "718-336-7139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATIHA",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2008-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "229099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02495889",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ayman Fathalla, MD
• Aysar Benyamen Fathallah-Mammo, MD
• Aya Fathy
• Bryanna Fatigate
• Ibrahim Fatiha, D.C. , RN, MSN
• Morris Fatiha
• Ajiya Fatima, MBBS
• Annum Fatima
• Aroob Fatima, M.D.
• Bilquees Fatima

• Family Medicine Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; 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.

Verify at the official NPI Registry.