NPIMap

Individual provider Active NPI

Raied Abdullah, M.D.

  • Nephrology Physician
  • Gary, IN
National Provider Identifier
1063417657
Registry record updated Feb 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
01052588A Issued in IN
Practice address
3229 Broadway
Suite 205
Gary, IN 46409-1036
Phone
(219) 887-4950
Fax
(219) 887-4955
NPI assigned
Jun 20, 2005
Last updated
Feb 14, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01052558 IN
Nephrology Physician 207RN0300X 01052588A IN Primary

Addresses

Primary practice location

3229 Broadway
Suite 205
Gary, IN 46409-1036

Mailing address

801 Macarthur Blvd
Suite 400a
Munster, IN 46321-2915
Phone (219) 931-5227

Other identifiers 1

IdentifierTypeStateIssuer
200264560MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20080801000376 IN Practitioner - NephrologyPractitioner - Internal Medicine 3173696887 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Rush Medical College of Rush University, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Specialists, P.C.Group PAC ID 2860454980, 10 clinicians

Practice addresses (Care Compare)

3229 Broadway
Suite 160
Gary, IN 46409-1036
Phone (219) 887-4950

521 E 86TH Ave
Suite K
Merrillville, IN 46410-6236
Phone (219) 769-5227

5500 Hohman Ave
Suite 1C
Hammond, IN 46320-1942
Phone (219) 832-4006

5823 US Hwy 6
Suite B
Portage, IN 46368-4851
Phone (219) 764-8020

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01052558INMDInternal Medicine Physician
01052588AINMDNephrology Physician

Interoperability endpoints

  • Direct secure messaging: rabdullah64241@direct.franciscanalliance.org
  • Direct secure messaging: raied.abdullah@direct.davitaphysiciansolutions.com

Organizations & group practices 1

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.

Hospital & facility affiliations 11

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": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392336000000",
    "number": "1063417657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 MACARTHUR BLVD",
            "address_2": "SUITE 400A",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212915",
            "telephone_number": "219-931-5227",
            "fax_number": "219-932-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3229 BROADWAY",
            "address_2": "SUITE 205",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464091036",
            "telephone_number": "219-887-4950",
            "fax_number": "219-887-4955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDULLAH",
        "first_name": "RAIED",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-20",
        "last_updated": "2014-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01052558",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01052588A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200264560",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gary, IN

Sources for this page

Verify at the official NPI Registry.