Farooque Azam

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95014104 Issued in CA

Practice address

12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331-1393

Phone

(818) 896-1161

Fax

(818) 896-5069

NPI assigned

Apr 7, 2020

Last updated

Apr 10, 2023By the provider in NPPES

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 3

Other names 1

• Farooque Azam Professional name

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sokyahealth Medical Group PCGroup PAC ID 8628463015, 180 clinicians

Talami Health and Wellness IncGroup PAC ID 2062820079, 17 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

59.04 of 100Reported as group

Quality

10

Improvement activities

40

Cost

50.15

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations (25 of 26)

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/9357/brand/1/csg/1/fhir/r4

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.

• Sokyahealth Medical Group PC

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1942970330
  Medicare reassignment Care Compare group NPD
• Talami Health & Wellness, Inc.

  • Urgent Care Clinic/Center
  • El Cajon, CA
  • NPI 1942895065
  Medicare reassignment Care Compare group NPD
• Bonita House, Inc.

  dba Supported Independent Living

  • Case Management Agency
  • Oakland, CA
  • NPI 1073728770
  Medicare reassignment NPD
• Ehab Yacoub MD Inc.

  dba Brain Health USA

  • Child & Adolescent Psychiatry Physician
  • Gardena, CA
  • NPI 1417373713
  Medicare reassignment NPD
• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Mellow Medical Inc a Professional Corporation

  • Psychiatry Physician
  • West Hollywood, CA
  • NPI 1407275886
  Medicare reassignment NPD
• Hillview Mental Health Center, Inc.

  • Adult Mental Health Clinic/Center
  • Pacoima, CA
  • NPI 1225073786
  Medicare reassignment
• Advanced TMS Clinic Inc

  • Clinic/Center
  • National City, CA
  • NPI 1386104263
  NPD
• Bonita House, Inc.

  dba Casa Ubuntu / CalWORKS Phoenix

  • Community/Behavioral Health Agency
  • Oakland, CA
  • NPI 1902253016
  NPD

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1689203093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12450 VAN NUYS BLVD STE 200",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913311393",
            "telephone_number": "818-896-1161",
            "fax_number": "818-896-5069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12450 VAN NUYS BLVD STE 200",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913311393",
            "telephone_number": "818-896-1161",
            "fax_number": "818-896-5069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1225 W 190th St Ste 280",
            "address_purpose": "LOCATION",
            "city": "Gardena",
            "state": "CA",
            "postal_code": "902484305",
            "country_code": "US",
            "telephone_number": "310-515-8113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AZAM",
        "first_name": "FAROOQUE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-07",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95014104",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "65014104",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7068",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7420",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6758",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FAROOQUE",
            "last_name": "AZAM",
            "credential": "FAROOQUE AZAM",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Gabriella Avalos Sarceno
• Maria Clementina Avalos
• Mariela Avalos
• Amanda Avila
• Ray Ayala
• Armen Azatian, M.D.
• Leah Bajulai
• Kristie Bane
• Edgar Banuelos
• Ronald Milton Barnes, MD

• Psychiatric/Mental Health Nurse Practitioner in Pacoima, CA
• Providers in Pacoima, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; 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.