NPIMap

Individual provider Active NPI

Samir Azzam, M.D

  • Family Medicine Physician
  • Anaheim, CA
National Provider Identifier
1891744538
Registry record updated Jun 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A51621 Issued in CA
Practice address
1211 W la Palma Ave Ste 707
Anaheim, CA 92801-2814
Phone
(714) 776-2100
Fax
(714) 776-1960
NPI assigned
May 9, 2006
Last updated
Jun 24, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A51621 CA
Family Medicine Physician 207Q00000X A51621 CA Primary

Addresses

Primary practice location

1211 W la Palma Ave Ste 707
Anaheim, CA 92801-2814

Mailing address

1211 W la Palma Ave Ste 707
Anaheim, CA 92801-2814
Phone (714) 776-2100

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
I20040823001590 CA Practitioner - Family Practice 6204800469 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1211 W la Palma Ave
Suite 707
Anaheim, CA 92801-2814
Phone (714) 776-2100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
17.06 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
56.88

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A51621CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hassan Ragab M D Inc Current Accepting new patients
Family Choice Aco Inc CurrentSince Jun 13, 2024 Accepting new patients
Samir Azzam MD Inc Family Medicine CurrentSince Dec 3, 2007 Accepting new patients
Healthcare Providers of California Medical Group, Inc PastSince Sep 22, 2005 Accepting new patients
Alta Newport Hospital, LLC Past Accepting new patients
Anaheim Memorial Medical Center Past Accepting new patients
Kenneth Rich MD Past Accepting new patients
Anaheim Terrace Care Center, LLC Past Accepting new patients
Anaheim Global Medical Center, Inc Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients
Orange County Global Medical Center, Inc Past Accepting new patients

Locations

1211 W La Palma Ave
Ste 707
Anaheim, CA 92801
Phone (714) 776-2100

7631 Wyoming St
Ste 201
Westminster, CA 92683
Phone (714) 898-0765

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Advanced Rehab Center of TustinSanta Ana, CA, CCN 055330 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 4, 2024
Jun 4, 2024
Bayshire Yorba Linda Post-AcuteYorba Linda, CA, CCN 555768 Skilled nursing facility Adp of the SNF Apr 1, 2024
Golding Care Hospice IncAnaheim, CA, CCN B21568 Hospice Contracted Managing Employee Apr 25, 2022

Owned or controlled facilities with NPI records 3

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

Organizations & group practices 11

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 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308873600000",
    "number": "1891744538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 W LA PALMA AVE STE 707",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012814",
            "telephone_number": "714-776-2100",
            "fax_number": "714-776-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 W LA PALMA AVE STE 707",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012814",
            "telephone_number": "714-776-2100",
            "fax_number": "714-776-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZZAM",
        "first_name": "SAMIR",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2011-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A51621",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A51621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.