NPIMap

Organization Active NPI

Moazam PA

  • Internal Medicine Physician
  • Thornton, CO
National Provider Identifier
1699043166
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
N6499 Issued in TX
Legal business name
MOAZAM PA
Practice address
1700 W 100TH Ave Ste 100
Thornton, CO 80260-5982
Phone
(915) 852-3225
NPI assigned
Dec 12, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Authorized official

Name
Dr. Mustafa Mohammed Moazam, M.D.NPI 1306987474
Title
Medical Director
Phone
(918) 691-9129

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Q3405 TX
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X N6499 TX Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X N6499 TX
Pediatric Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0207X N6499 TX

Addresses

Primary practice location

1700 W 100TH Ave Ste 100
Thornton, CO 80260-5982

Mailing address

14470 Horizon Blvd
Ste J
Horizon City, TX 79928-7695
Phone (915) 852-3225

Other practice location 1

14470 Horizon Blvd
Ste J
Horizon City, TX 79928-7695
Phone (915) 852-3225

Other names 1

  • Healthy horizons Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CO, NM3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20120409000135 TX Part B Supplier - Clinic/Group Practice 4486815008 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
Practice locations: El Paso, TX; Pasadena, TX; Horizon City, TX
O20160818001314 CO Part B Supplier - Clinic/Group Practice 4486815008 Receives reassigned benefits from 6 practitioners
Practice locations: Thornton, CO
O20161019002405 NM Part B Supplier - Clinic/Group Practice 4486815008 Receives reassigned benefits from 5 practitioners
Practice locations: Deming, NM; Las Cruces, NM

National Provider Directory

National Provider Directory
Tax ID family
Healthy Horizons Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1700 W 100th Ave
Thornton, CO 80260
Phone (720) 388-7071

7888 Gateway Blvd E
Ste B2
El Paso, TX 79915

935 Sunland Park Dr
Ste 101102
El Paso, TX 79922

3329 Montana Ave
El Paso, TX 79903
Phone (915) 562-7101

7888 Gateway Blvd E
Fl 2
El Paso, TX 79915
Phone (915) 300-3484

10921 Pellicano Dr
Ste 121
El Paso, TX 79935
Phone (915) 320-7707

935 Sunland Park Dr
Ste 101
El Paso, TX 79922

6955 N Mesa St
Ste 104
El Paso, TX 79912
Phone (915) 444-2668

14470 Horizon Blvd
Ste Aj
Horizon City, TX 79928

14470 Horizon Blvd
Ste A
Horizon City, TX 79928

Ownership & related parties

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2152522Healthy Horizons Clinic1700 W 100TH Ave, Thornton, CO 80260Certificate of waiverFeb 13, 2027
45D2115586Moazam PA14470 Horizon Blvd,Ste J, Horizon City, TX 79928Certificate of waiverJul 10, 2028

NPI Registry JSON

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

{
    "created_epoch": "1323648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1699043166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14470 HORIZON BLVD",
            "address_2": "STE J",
            "city": "HORIZON CITY",
            "state": "TX",
            "postal_code": "799287695",
            "telephone_number": "915-852-3225",
            "fax_number": "915-209-8289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 W 100TH AVE STE 100",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802605982",
            "telephone_number": "915-852-3225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14470 Horizon Blvd",
            "address_2": "Ste J",
            "address_purpose": "LOCATION",
            "city": "Horizon City",
            "state": "TX",
            "postal_code": "799287695",
            "country_code": "US",
            "telephone_number": "915-852-3225",
            "fax_number": "915-209-8289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOAZAM PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-12",
        "last_updated": "2022-07-18",
        "certification_date": "2022-05-27",
        "status": "A",
        "authorized_official_last_name": "MOAZAM",
        "authorized_official_first_name": "MUSTAFA",
        "authorized_official_middle_name": "MOHAMMED",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "918-691-9129",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "Q3405",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N6499",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "N6499",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "TX",
            "license": "N6499",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthy horizons Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Healthy horizons Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thornton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.