NPIMap

Individual provider Active NPI

Awad Anthony, M.D

  • Family Medicine Physician
  • Hollywood, CA
National Provider Identifier
1811047830
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A43036 Issued in CA
Practice address
6368 Hollywood Blvd
Hollywood, CA 90028-6320
Phone
(323) 469-5555
NPI assigned
Jan 11, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A43036 CA Primary

Addresses

Primary practice location

6368 Hollywood Blvd
Hollywood, CA 90028-6320

Mailing address

6368 Hollywood Blvd
Hollywood, CA 90028-6320
Phone (323) 469-5555

Other identifiers 1

IdentifierTypeStateIssuer
00A430360MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20160811001458 CA Order and Referring Only - Family PracticePractitioner - Family Practice 8921991639

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A43036CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Anthony Medical Centers PastSince Jan 2, 2001 Accepting new patients
St Anthony Medical Centers Past Accepting new patients
Southern California Healthcare System, Inc Past Accepting new patients
Cha Hollywood Medical Center, LP Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St Anthony Medical CentersLos Angeles, CA, CCN 051031 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jan 3, 2000
Jan 3, 2000
St Anthony Medical CentersLos Angeles, CA, CCN 051029 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jan 3, 2000
Jan 3, 2000
St Anthony Medical CentersLos Angeles, CA, CCN 051030 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jan 3, 2000
Jan 3, 2000
St Anthony Medical CentersHawthorne, CA, CCN A11014 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jan 3, 2000
Jan 3, 2000

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811047830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6368 HOLLYWOOD BLVD",
            "city": "HOLLYWOOD",
            "state": "CA",
            "postal_code": "900286320",
            "telephone_number": "323-469-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6368 HOLLYWOOD BLVD",
            "city": "HOLLYWOOD",
            "state": "CA",
            "postal_code": "900286320",
            "telephone_number": "323-469-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTHONY",
        "first_name": "AWAD",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A43036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A430360",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, CA

Sources for this page

Verify at the official NPI Registry.