NPIMap

Individual provider Active NPI

Mahmoud Youssef Abdallah, DO

  • Pulmonary Disease Physician
  • Garden Grove, CA
National Provider Identifier
1871014027
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
20A16964 Issued in CA
Practice address
12462 Brookhurst St Ste a&B
Garden Grove, CA 92840-4759
Phone
(714) 636-9850
NPI assigned
Jun 28, 2017
Last updated
Sep 8, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20A16964 CA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 20A16964 CA
Pulmonary Disease Physician 207RP1001X 20A16964 CA Primary

Addresses

Primary practice location

12462 Brookhurst St Ste a&B
Garden Grove, CA 92840-4759

Mailing address

3033 W Orange Ave
Anaheim, CA 92804-3156

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
I20231004004144 CA Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 7214399302 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathway Medical Group IncGroup PAC ID 5092776690, 17 clinicians

Practice addresses (Care Compare)

12462 Brookhurst St
Suite Aandb
Garden Grove, CA 92840-4759
Phone (714) 636-9852

7955 Westminster Blvd
Westminster, CA 92683-4001
Phone (714) 379-3221

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16964CAMDClinical Social Worker
20A16964CAMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pathway Medical Group, Inc Internal Medicine Current Accepting new patients
Pathway Medical Group, Inc. Internal Medicine CurrentSince Oct 1, 2023 Accepting new patients
Pathway Medical Group, Inc Internal Medicine CurrentSince Oct 1, 2023 Accepting new patients
Pathway Medical Group, Inc Current Accepting new patients

Locations

12462 Brookhurst St
Garden Grove, CA 92840
Phone (714) 379-3221

12462 Brookhurst St
Ste Ab
Garden Grove, CA 92840
Phone (714) 636-9850

7955 Westminster Blvd
Westminster, CA 92683
Phone (714) 379-2411

Organizations & group practices 4

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 5

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": "1498608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1871014027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3033 W ORANGE AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12462 BROOKHURST ST STE A&B",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928404759",
            "telephone_number": "714-636-9850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDALLAH",
        "first_name": "MAHMOUD",
        "middle_name": "YOUSSEF",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-28",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A16964",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CA",
            "license": "20A16964",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "20A16964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.