NPIMap

Individual provider Active NPI

Haitham Boulos Haddad, M.D.

  • Internal Medicine Physician
  • Grants Pass, OR
National Provider Identifier
1922003714
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD18812 Issued in OR
Practice address
495 SW Ramsey Ave
Grants Pass, OR 97527
Phone
(541) 476-6644
Fax
(541) 472-5673
NPI assigned
Jun 17, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

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
Internal Medicine Physician 207R00000X MD18812 OR Primary

Addresses

Primary practice location

495 SW Ramsey Ave
Grants Pass, OR 97527

Mailing address

495 SW Ramsey Ave
Grants Pass, OR 97527
Phone (541) 476-6644

Other identifiers 1

IdentifierTypeStateIssuer
149976MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20040524001289 OR Practitioner - Internal Medicine 0648261917 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Loma Linda University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Grants Pass Clinic LLPGroup PAC ID 9234123977, 16 clinicians

Practice addresses (Care Compare)

495 SW Ramsey Ave
Grants Pass, OR 97527-5681
Phone (541) 476-6644

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD18812ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grants Pass Clinic LLP Internal Medicine CurrentSince Jul 14, 1994 Accepting new patients
Asante Three Rivers Medical Center, LLC CurrentSince May 1, 2004 Accepting new patients

Locations

495 SW Ramsey Ave
Grants Pass, OR 97527
Phone (541) 476-6644

Interoperability endpoints

  • Direct secure messaging: haithamhaddad@gpc.allscriptsdirect.net
  • Direct secure messaging: haithamhaddad@grantspass.allscriptsdirect.net

Organizations & group practices 2

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 8

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": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922003714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 SW RAMSEY AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "97527",
            "telephone_number": "541-476-6644",
            "fax_number": "541-472-5673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 SW RAMSEY AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "97527",
            "telephone_number": "541-476-6644",
            "fax_number": "541-472-5673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDAD",
        "first_name": "HAITHAM",
        "middle_name": "BOULOS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD18812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149976",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

Verify at the official NPI Registry.