NPIMap

Individual provider Active NPI

Bassam Mouazzen, M.D.

  • Specialist
  • Glendora, CA
National Provider Identifier
1952492712
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
C43066 Issued in CA
Practice address
415 W Route 66
Suite 101
Glendora, CA 91740-4335
Phone
(626) 852-9986
Fax
(626) 963-2220
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X C43066 CA Primary

Addresses

Primary practice location

415 W Route 66
Suite 101
Glendora, CA 91740-4335

Mailing address

PO Box 1939
Glendora, CA 91740-1939
Phone (626) 852-9986

Other identifiers 2

IdentifierTypeStateIssuer
RHC140778OtherCAFLOUROSCOPY
1625227MedicaidCA

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
I20081024000370 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0143388850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

415 W Route 66
Suite 101
Glendora, CA 91740-4335
Phone (626) 852-9986

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 Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Prime Healthcare Services - Montclair, LLC Past Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Emanate Health Foothill Presbyterian Hospital Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 6

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 4

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": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1952492712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1939",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917401939",
            "telephone_number": "626-852-9986",
            "fax_number": "626-963-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W ROUTE 66",
            "address_2": "SUITE 101",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404335",
            "telephone_number": "626-852-9986",
            "fax_number": "626-963-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUAZZEN",
        "first_name": "BASSAM",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "C43066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLOUROSCOPY",
            "identifier": "RHC140778",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1625227",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

Verify at the official NPI Registry.