Individual provider Active NPI

Wissam Dahoud, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Long Beach, CA
National Provider Identifier
1932587649
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
A171655 Issued in CA
Practice address
2801 Atlantic Ave
Long Beach, CA 90806-1701
Phone
(562) 933-0716
NPI assigned
May 13, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X D89870 MD
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X A171655 CA Primary

Addresses

Primary practice location

2801 Atlantic Ave
Long Beach, CA 90806-1701

Mailing address

File 1319; 1801 Olympic Blvd
Pasadena, CA 91199-1319
Phone (314) 849-3535

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200716002765 MD Practitioner - Pathology 8123442639 Reassigns benefits to 1 organization
I20210609000390 CA Practitioner - Pathology 8123442639 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Long Beach Memorial Pathology Medical Group, Inc.Group PAC ID 8426001363, 12 clinicians

Practice addresses (Care Compare)

2801 Atlantic Ave
Long Beach, CA 90806-1701
Phone (562) 933-0716

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.95 of 100Reported as group
Quality
58
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A171655CAMDAnatomic Pathology & Clinical Pathology Physician
D89870MDMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jun 19, 2023 Accepting new patients
Johns Hopkins University Anatomic Pathology & Clinical Pathology CurrentSince Jul 1, 2020 Accepting new patients
Long Beach Memorial Pathology Medical Group, Inc. Anatomic Pathology & Clinical Pathology CurrentSince Jul 6, 2021 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Long Beach Memorial Pathology Medical Group Inc. CurrentSince Jul 6, 2021 Accepting new patients
Johns Hopkins University CurrentSince Jul 1, 2020 Accepting new patients
Johns Hopkins University Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Jun 19, 2023 Accepting new patients

Locations

9333 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-3340

9333 Imperial Hwy
Downey, CA 90242
Phone (562) 657-8850

2801 Atlantic Ave
Long Beach, CA 90806
Phone (310) 933-2000

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

1801 W Olympic Blvd
Pasadena, CA 91199

5755 Cedar Ln
Columbia, MD 21044
Phone (410) 381-7171

6201 Greenleigh Ave
Middle River, MD 21220
Phone (410) 933-2704

Interoperability endpoints

  • Direct secure messaging: wdahoud693761@direct.memorialcare.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1431475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1932587649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 1319; 1801 OLYMPIC BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911991319",
            "telephone_number": "314-849-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 ATLANTIC AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061701",
            "telephone_number": "562-933-0716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHOUD",
        "first_name": "WISSAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-13",
        "last_updated": "2023-06-28",
        "certification_date": "2022-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MD",
            "license": "D89870",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "A171655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9333 Imperial Hwy",
            "city": "Downey",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902422812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.