Hussam Fuad Eid Al-Jawaldeh, MD
Individual provider Active NPI Internal Medicine Physician · Sierra Vista, AZ
NPI 1992376057 · NPPES record last updated Aug 10, 2024
Key facts
- NPI
- 1992376057
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 71647 (AZ)
- Practice address
- 5700 E Highway 90
Sierra Vista, AZ 85635-9110 - Phone
- (520) 263-2000
- NPI assigned
- Jul 8, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cogent Healthcare of Arizona PC
Practice addresses (Care Compare)
5700 E Hwy 90
Sierra Vista, AZ 85635-9110
Phone (520) 417-4594
Hospital & facility affiliations
- Canyon Vista Medical Center
- Banner - University Medical Center Tucson Campus
- St. Mary'S Hospital
- Copper Queen Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241104003780 | AZ | Practitioner - Internal Medicine | 6406389071 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R78879 | AZ | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cogent Healthcare of Arizona PC | Single Specialty | Current |
Accepting new patients |
| RCHP-Sierra Vista Inc | Past | Accepting new patients |
Locations
5700 E Highway 90
Sierra Vista, AZ 85635
Phone (520) 263-2000
120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | R78879 | AZ | |
| Internal Medicine Physician | 207R00000X | 71647 | AZ | Yes |
Addresses
Primary practice location
5700 E Highway 90
Sierra Vista, AZ 85635-9110
Mailing address
289 S Highway 92 Apt 3202
Sierra Vista, AZ 85635-3681
Phone (520) 678-2379
Other providers in Sierra Vista, AZ
- Akdhc, LLC
- Rahil Akhtar
- Yahya Munaf Salim Al Attraqchi
- Layla Al Safadi Abou Al Fadel
- Shadi Samer Al-Deir
- Alan P Kawakami DDS PC
- Dana J Albalate
- Regina Lenette Allen
- Alliance Healthcare Services Inc
- Angela Allred
All providers in Sierra Vista, AZ · Internal Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.