Individual provider Active NPI

Lydia Tarek Ghabour, PA

  • Medical Physician Assistant
  • Loma Linda, CA
National Provider Identifier
1780329938
Registry record updated Mar 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA62139 Issued in CA
Practice address
25455 Barton Rd Ste 204B
Loma Linda, CA 92354-3130
Phone
(909) 558-6600
NPI assigned
May 2, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA62139 CA Primary

Addresses

Primary practice location

25455 Barton Rd Ste 204B
Loma Linda, CA 92354-3130

Mailing address

File # 54701
Los Angeles, CA 90074-4701
Phone (909) 558-6600

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
I20230125001059 CA Practitioner - Physician Assistant 9830560150 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11370 Anderson St
Loma Linda, CA 92354-3450

25455 Barton Rd
Suite 108a
Loma Linda, CA 92354-3139
Phone (909) 558-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.87 of 100Reported as group
Quality
72.13
Promoting interoperability
80
Improvement activities
40
Cost
77.36

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain View Urgent Care Group, Inc CurrentSince Jan 1, 2023 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Mar 16, 2024 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Mar 16, 2024 Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients

Locations

81 Highland Springs Ave
Ste 103
Beaumont, CA 92223
Phone (909) 558-2830

12442 Limonite Ave
Unit 102
Eastvale, CA 91752
Phone (951) 393-3000

16465 Sierra Lakes Pkwy
Ste 100
Fontana, CA 92336
Phone (909) 434-1150

25455 Barton Rd
Ste 204B
Loma Linda, CA 92354
Phone (909) 558-6526

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

25455 Barton Rd
Ste 108A
Loma Linda, CA 92354
Phone (909) 558-1617

11234 Anderson St
#A600
Loma Linda, CA 92350
Phone (909) 558-2824

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

File 54701
Los Angeles, CA 90074
Phone (909) 651-4300

255 E Bonita Ave
Pomona, CA 91767
Phone (866) 724-4127

Interoperability endpoints

  • Direct secure messaging: lghabour1085925@direct.llu.edu

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1651449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711152000000",
    "number": "1780329938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE # 54701",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900744701",
            "telephone_number": "909-558-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25455 BARTON RD STE 204B",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543130",
            "telephone_number": "909-558-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHABOUR",
        "first_name": "LYDIA",
        "middle_name": "TAREK",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-02",
        "last_updated": "2024-03-23",
        "certification_date": "2024-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA62139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.