NPIMap

Individual provider Active NPI

Therese A Ibrahim, MD

  • Family Medicine Physician
  • Ormond Beach, FL
National Provider Identifier
1063514172
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME94322 Issued in FL
Practice address
420 S Nova Rd Ste 4&5
Ormond Beach, FL 32174-0410
Phone
(386) 615-8122
Fax
(844) 899-3686
NPI assigned
Sep 1, 2006
Last updated
Feb 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME94322 FL Primary

Addresses

Primary practice location

420 S Nova Rd Ste 4&5
Ormond Beach, FL 32174-0410

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address therese.ibrahim.1@29601.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20080319000022 FL Practitioner - Family Practice 5890871768 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conviva Medical Center Management, LLCGroup PAC ID 4284717422, 507 clinicians

Practice addresses (Care Compare)

420 S Nova Rd
Suite 4And5
Ormond Beach, FL 32174-0410
Phone (386) 615-8122

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME94322FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Conviva Medical Center Management LLC Family Medicine CurrentSince Jan 1, 2021 Accepting new patients
Florida Health Care Plan, Inc Past Accepting new patients
Metcare of Florida, Inc Past Accepting new patients

Locations

5238 Norwood Ave
#16
Jacksonville, FL 32208
Phone (904) 265-2050

6101 Blue Lagoon Dr
Ste 400
Miami, FL 33126
Phone (305) 500-2114

6101 Waterford District Dr
Ste 200
Miami, FL 33126
Phone (407) 533-6836

420 S Nova Rd
Ste 4
Ormond Beach, FL 32174
Phone (386) 506-0111

420 S Nova Rd
Ste 45
Ormond Beach, FL 32174
Phone (386) 281-6633

1430 SW Saint Lucie West Blvd
Ste 101
Port St Lucie, FL 34986
Phone (772) 877-3591

Interoperability endpoints

  • Direct secure messaging: therese.ibrahim.1@29601.direct.athenahealth.com

Organizations & group practices 3

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 7

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": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1063514172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S NOVA RD STE 4&5",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321740410",
            "telephone_number": "386-615-8122",
            "fax_number": "844-899-3686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "THERESE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-01",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME94322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "therese.ibrahim.1@29601.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "420 S Nova Rd Ste 4&5",
            "city": "Ormond Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321740410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ormond Beach, FL

Sources for this page

Verify at the official NPI Registry.