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Individual provider Active NPI

Farajallah M Hanna Al-Kass, M.D.

  • Diagnostic Radiology Physician
  • Iowa City, IA
National Provider Identifier
1790984607
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
260657 Issued in NY
Practice address
200 Hawkins Dr
Dept. of Radiology
Iowa City, IA 52242-1009
Phone
(319) 356-8218
NPI assigned
Jul 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 4301087094 MI
Vascular & Interventional Radiology Physician 2085R0204X 6456 IA
Diagnostic Radiology Physician 2085R0202X 260657 NY Primary

Addresses

Primary practice location

200 Hawkins Dr
Dept. of Radiology
Iowa City, IA 52242-1009

Mailing address

411 N Central Ave Ste 200
Glendale, CA 91203-2092
Phone (818) 745-6463

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070801000019 MI Practitioner - Interventional Pain ManagementPractitioner - Diagnostic RadiologyPractitioner - Nuclear Medicine 3274624580 Reassigns benefits to 1 organization
I20181120003192 CA Practitioner - Interventional Radiology 3274624580 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Radiology
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

411 N Central Ave
Suite 200
Glendale, CA 91203-2092
Phone (818) 745-6463

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Tumor Registrar, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6456IAMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Radadvantage a Professional Corporation Diagnostic Radiology CurrentSince Aug 18, 2019 Accepting new patients
California Vascular Health Institute LLC CurrentSince Jan 17, 2024 Accepting new patients
Riverwalk Medical Corporation Specialist Current Accepting new patients
Riverwalk Medical Corporation Vascular & Interventional Radiology CurrentSince Apr 8, 2019 Accepting new patients
Dr L Reynolds Assoc PC Specialist Past Accepting new patients

Locations

5020 Commerce Dr
Bakersfield, CA 93309

5020 Commerce Dr
#C
Bakersfield, CA 93309

411 N Central Ave
Ste 200
Glendale, CA 91203
Phone (818) 696-1600

1 William Carls Dr
Commerce Twp, MI 48382
Phone (248) 227-5500

101 Hospital Rd
Patchogue, NY 11772
Phone (631) 654-7100

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 3

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": "1184198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1790984607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 N CENTRAL AVE STE 200",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032092",
            "telephone_number": "818-745-6463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR",
            "address_2": "DEPT. OF RADIOLOGY",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-356-8218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNA AL-KASS",
        "first_name": "FARAJALLAH",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-12",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301087094",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IA",
            "license": "6456",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "260657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Iowa City, IA

Sources for this page

Verify at the official NPI Registry.