Individual provider Active NPI

Hanan Bashar Abdelfattah, PA

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1699230953
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA56240 Issued in CA
Practice address
1225 Wilshire Blvd
Los Angeles, CA 90017-1901
Phone
(213) 977-2121
NPI assigned
Jan 31, 2019
Last updated
Sep 8, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA56240 CA Primary

Addresses

Primary practice location

1225 Wilshire Blvd
Los Angeles, CA 90017-1901

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (213) 977-2121

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190404001553 CA Practitioner - Physician Assistant 8820339658 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA56240CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Feb 1, 2019 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Feb 1, 2019 Accepting new patients

Locations

1225 Wilshire Blvd
Los Angeles, CA 90017
Phone (213) 482-2741

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1699230953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "213-977-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900171901",
            "telephone_number": "213-977-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDELFATTAH",
        "first_name": "HANAN",
        "middle_name": "BASHAR",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-31",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA56240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.