Deinma Ibulubo, RN, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

363715 Issued in NY

Practice address

2054 Tillotson Ave
Bronx, NY 10475-1560

Phone

(718) 671-2100

NPI assigned

Nov 1, 2012

Last updated

Oct 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, PA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Penn State Health Medical Group LLCGroup PAC ID 8729351077, 720 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Penn State Health Hampden Medical Center Hospital, Enola, PA, CCN 390336

Merit-based Incentive Payment System (MIPS)

Final score

82.85 of 100Reported as group

Quality

65.84

Promoting interoperability

100

Improvement activities

40

Cost

77

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

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.

• Penn State Health Medical Group, LLC

  • Hematology & Oncology Physician
  • Harrisburg, PA
  • NPI 1861988644
  Medicare reassignment Care Compare group NPD
• Bronxcare Health System

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1245390855

  Nurse Practitioner

  Medicare reassignment NPD
• Medical Director Services PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Princess Anne, MD
  • NPI 1871955807

  NY

  Medicare reassignment NPD
• Bronxcare Health System

  • Clinical Social Worker
  • Bronx, NY
  • NPI 1326115692
  NPD
• Bronxcare Health System

  • Methadone Clinic
  • Bronx, NY
  • NPI 1801428222
  NPD
• Penn State Health Medical Group, LLC

  • Diagnostic Radiology Physician
  • Harrisburg, PA
  • NPI 1457824013
  NPD
• Penn State Health Medical Group, LLC

  • Dermatology Physician
  • Camp Hill, PA
  • NPI 1407500143
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Penn State Health Hampden Medical Center

  • General Acute Care Hospital
  • Enola, PA
  • NPI 1164029658
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1013261866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1276 FULTON AVE RM 219",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563402",
            "telephone_number": "718-992-7669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2054 TILLOTSON AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104751560",
            "telephone_number": "718-671-2100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104577606",
            "country_code": "US",
            "telephone_number": "718-992-7669",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "503 N 21st St",
            "address_purpose": "LOCATION",
            "city": "Camp Hill",
            "state": "PA",
            "postal_code": "170112204",
            "country_code": "US",
            "telephone_number": "717-972-4448",
            "fax_number": "717-972-7366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBULUBO",
        "first_name": "DEINMA",
        "credential": "RN, FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-01",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "647036",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP023507",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "363715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariam Naem Ibrahim, MD
• Nafisa Dalia Ibrahim, MSW
• Nura Abdul-Mumuni Ibrahim, LPN
• Radwa Ibrahim, DO
• Reema Ibrik, MD
• Icare RX Pharmacy Corporation (Icare Pharmacy)
• Icl Bronx Park East
• Icl East 170TH Street (Icf)
• Icl East 225TH Street
• Pamela Icochea Calenzani, MPH., MAPP

• Family Nurse Practitioner in Bronx, NY
• Providers in Bronx, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.