Kaniz Fatema Islam, FNP, PMHNP - Medicare Nurse Practitioner in Laveen, AZ

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Kaniz Fatema Islam, FNP, PMHNP is a medicare enrolled "Nurse Practitioner - Family" in Laveen, Arizona. Her current practice location is 5209 W Siesta Way, Laveen, Arizona. You can reach out to her office (for appointments etc.) via phone at (602) 352-9898.

Kaniz Fatema Islam is licensed to practice in Arizona (license number AZ5476) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1366860843.

Contact Information

Kaniz Fatema Islam, FNP, PMHNP
5209 W Siesta Way,
Laveen, AZ 85339-7179
(602) 352-9898
(949) 247-5542

Map and Direction




Provider's Profile

Full NameKaniz Fatema Islam
GenderFemale
SpecialityNurse Practitioner - Family
Location5209 W Siesta Way, Laveen, Arizona
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1366860843
  • Provider Enumeration Date: 04/02/2014
  • Last Update Date: 05/20/2026
  Medicare PECOS Information:
  • PECOS PAC ID: 2264656552
  • Enrollment ID: I20140605002058

Medical Identifiers

Medical identifiers for Kaniz Fatema Islam such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1366860843NPI-NPPES
902324MedicaidAZ

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LP0808XNurse Practitioner - Psychiatric/mental Health AZ5476 (Arizona)Secondary
363LF0000XNurse Practitioner - Family AZ5476 (Arizona)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kaniz Fatema Islam allows following entities to bill medicare on her behalf.
Entity NameCeb Capital Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1750754982
PECOS PAC ID: 0244537561
Enrollment ID: O20160330002570

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kaniz Fatema Islam is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Kaniz Fatema Islam, FNP, PMHNP
5209 W Siesta Way,
Laveen, AZ 85339-7179

Ph: (602) 550-1008		Kaniz Fatema Islam, FNP, PMHNP
5209 W Siesta Way,
Laveen, AZ 85339-7179

Ph: (602) 352-9898

Reviews and Comments


Nurse Practitioner Nurses in Laveen, AZ

Kendall Karn, FNP-C
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Sukran Hong, FNP-BC
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Practice Location: 8821 S 40th Dr, Laveen, AZ 85339
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Isin Santos, PMHNP
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Medicare: May Accept Medicare Assignments
Practice Location: 7205 S 51st Ave Ste 203, Laveen, AZ 85339
Phone: 602-358-7073    Fax: 888-927-0409
Mrs. Suja Varghese, FNP-C
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Practice Location: 17487 S Healthcare Dr, Laveen, AZ 85339
Phone: 602-528-1200    Fax: 520-550-6292
Norbert N Mwangi, FNP
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Practice Location: 5099 W Dobbins Rd Unit B, Laveen, AZ 85339
Phone: 602-688-2338    Fax: 949-222-3462
Natalie Cassandra Barajas, FNP-C
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Medicare: Accepting Medicare Assignments
Practice Location: 5050 W Baseline Rd, Laveen, AZ 85339
Phone: 866-389-2727    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.