Individual provider Active NPI

Ahmed Abdelaziz Abdelaziz, MD

  • Obstetrics & Gynecology Physician
  • Santa Maria, CA
National Provider Identifier
1790039733
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
142800 Issued in CA
Practice address
1418 E Main St
Suite 210
Santa Maria, CA 93454-4833
Phone
(805) 928-3678
Fax
(805) 928-6408
NPI assigned
Oct 30, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 4301101741 MI
Obstetrics & Gynecology Physician 207V00000X 142800 CA Primary

Addresses

Primary practice location

1418 E Main St
Suite 210
Santa Maria, CA 93454-4833

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8028

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161024001835 CA Practitioner - Obstetrics/Gynecology 9739467903 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

10800 Magnolia Ave
Riverside, CA 92505-3043
Phone (951) 353-2000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301101741MIMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Centers of the Central Coast Inc CurrentSince Oct 1, 2016 Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Community Health Centers of the Central Coast Inc CurrentSince Oct 1, 2016 Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 24, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 24, 2023 Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients

Locations

4723 W Main St
Ste H
Guadalupe, CA 93434
Phone (805) 343-2004

150 Tejas Pl
Nipomo, CA 93444
Phone (805) 929-3254

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

2050 S Blosser Rd
Santa Maria, CA 93458
Phone (805) 361-8014

2801 Santa Maria Way
Bldg A
Santa Maria, CA 93455
Phone (805) 938-9200

1418 E Main St
Ste 210
Santa Maria, CA 93454
Phone (805) 928-3678

210 S Palisade Dr
Santa Maria, CA 93454
Phone (805) 361-8014

325 Posada Ln
Templeton, CA 93465
Phone (805) 239-0644

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1790039733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8028",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 E MAIN ST",
            "address_2": "SUITE 210",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544833",
            "telephone_number": "805-928-3678",
            "fax_number": "805-928-6408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDELAZIZ",
        "first_name": "AHMED",
        "middle_name": "ABDELAZIZ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-30",
        "last_updated": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "MI",
            "license": "4301101741",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "142800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Maria, CA

Sources for this page

Verify at the official NPI Registry.