NPIMap

Organization Active NPI

Pathway Medical Group, Inc

  • Family Medicine Physician
  • Garden Grove, CA
National Provider Identifier
1902853302
Registry record updated May 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PATHWAY MEDICAL GROUP, INC
Practice address
12555 Garden Grove Blvd
#507
Garden Grove, CA 92843-1902
Phone
(714) 534-2222
Fax
(714) 534-0818
NPI assigned
May 30, 2006
Organization subpart
Yes
Parent organization
PATHWAY MEDICAL GROUP, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 6, 2008

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

Authorized official

Name
Dr. Hassan M. Alkhouli, M.D.
Title
C.E.O.
Phone
(714) 379-3221

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

12555 Garden Grove Blvd
#507
Garden Grove, CA 92843-1902

Mailing address

PO Box 2989
Seal Beach, CA 90740-1989
Phone (714) 379-3221

Other identifiers 1

IdentifierTypeStateIssuer
GR0100560MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041026000511 CA Part B Supplier - Clinic/Group Practice 5092776690 Receives reassigned benefits from 28 practitioners
6 other NPIs on this enrollment
Practice locations: Westminster, CA; Garden Grove, CA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Pathway Medical Group Inc

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210032000000",
    "number": "1902853302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2989",
            "city": "SEAL BEACH",
            "state": "CA",
            "postal_code": "907401989",
            "telephone_number": "714-379-3221",
            "fax_number": "714-379-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12555 GARDEN GROVE BLVD",
            "address_2": "#507",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431902",
            "telephone_number": "714-534-2222",
            "fax_number": "714-534-0818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHWAY MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATHWAY MEDICAL GROUP, INC",
        "enumeration_date": "2006-05-30",
        "last_updated": "2008-05-06",
        "status": "A",
        "authorized_official_last_name": "ALKHOULI",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "714-379-3221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0100560",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.