NPIMap

Individual provider Active NPI

Dahan Hussein Al-Fadhl, M.D.

  • Internal Medicine Physician
  • Mishawaka, IN
National Provider Identifier
1740235183
Registry record updated Sep 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01053045 Issued in IN
Practice address
611 E Douglas
Suite 309
Mishawaka, IN 46545-1467
Phone
(574) 335-6232
Fax
(574) 335-6233
NPI assigned
May 24, 2006
Last updated
Sep 14, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01053045 IN Primary

Addresses

Primary practice location

611 E Douglas
Suite 309
Mishawaka, IN 46545-1467

Mailing address

707 E Cedar St
Ste 200
South Bend, IN 46617-2057
Phone (574) 335-8700

Other identifiers 3

IdentifierTypeStateIssuer
200300400AMedicaidIN
000000568251OtherINBCBS
000000710327OtherINBCBS-HOSPITALIST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081002000648 IN Practitioner - Internal Medicine 8022186170 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Honor Physicians LLCGroup PAC ID 4981938164, 4 clinicians

Practice addresses (Care Compare)

3809 N Main St
Suite 100
Mishawaka, IN 46545-3109
Phone (574) 520-1700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01053045INMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Physicians of Indiana, LLC Internal Medicine CurrentSince Sep 4, 2018 Accepting new patients
Honor Physicians, LLC CurrentSince Jul 1, 2019 Accepting new patients
Sound Physicians of Indiana, LLC Internal Medicine CurrentSince Sep 4, 2018 Accepting new patients
Sound Physicians of Indiana, LLC Internal Medicine Current Accepting new patients
Hospitalist Medicine Physicians of Indiana, LLC Internal Medicine CurrentSince Oct 1, 2015 Accepting new patients
Saint Joseph Regional Medical Center, Inc. Internal Medicine Past Accepting new patients

Locations

601 W 2nd St
Bloomington, IN 47403
Phone (812) 353-5252

3809 N Main St
Ste 100
Mishawaka, IN 46545
Phone (574) 520-1700

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

Interoperability endpoints

  • Direct secure messaging: dahan.al-fadhl.1@22250.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1740235183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 E CEDAR ST",
            "address_2": "STE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172057",
            "telephone_number": "574-335-8700",
            "fax_number": "574-335-0760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS",
            "address_2": "SUITE 309",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451467",
            "telephone_number": "574-335-6232",
            "fax_number": "574-335-6233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL-FADHL",
        "first_name": "DAHAN",
        "middle_name": "HUSSEIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01053045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200300400A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000568251",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-HOSPITALIST",
            "identifier": "000000710327",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.