NPIMap

Individual provider Active NPI

Nowoghomwenma Charles Ibie, MD

  • Nephrology Physician
  • Dothan, AL
National Provider Identifier
1073742953
Registry record updated Mar 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD.30540 Issued in AL
Practice address
207 Haven Dr
Dothan, AL 36301-2919
Phone
(334) 793-3319
Fax
(334) 793-2291
NPI assigned
Jul 13, 2009
Last updated
Mar 8, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD.30540 AL
Internal Medicine Physician 207R00000X 30540 AL
Nephrology Physician 207RN0300X MD.30540 AL Primary

Addresses

Primary practice location

207 Haven Dr
Dothan, AL 36301-2919

Mailing address

207 Haven Dr
Dothan, AL 36301-2919
Phone (334) 793-3319

Other identifiers 4

IdentifierTypeStateIssuer
1073742953OtherALTRICARE SOUTH
Z14079OtherALVIVA HEALTH
511-12500OtherALBCBS
125314MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110125000396 AL Practitioner - Internal MedicinePractitioner - Emergency Medicine 8729267638 Reassigns benefits to 8 organizations
I20140609001095 SC Practitioner - Nephrology 8729267638 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Emergency Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dothan Hypertension Nephrology AssociatesGroup PAC ID 5991746661, 11 clinicians

Practice addresses (Care Compare)

207 Haven Dr
Dothan, AL 36301-2919
Phone (334) 793-3319

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36620SCMDPharmacotherapy Pharmacist
30540ALMDInternal Medicine Physician
MD.30540ALMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dothan Hypertension Nephrology Associates CurrentSince May 1, 2016 Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc Internal Medicine CurrentSince Jul 7, 2015 Accepting new patients
Correct Care, Inc. Emergency Medicine CurrentSince Jul 19, 2012 Accepting new patients
Greater Mobile Urgent Care CurrentSince Aug 1, 2011 Accepting new patients
State of Alabama Dept of Finance CurrentSince Jul 1, 2011 Accepting new patients
State of Alabama Dept of Finace CurrentSince Jul 1, 2011 Accepting new patients
Carolina Kidney & Hypertension Center, LLC Nephrology CurrentSince Jul 15, 2014 Accepting new patients
South Carolina Group Services, LLC CurrentSince Mar 17, 2015 Accepting new patients
State of Alabama Dept of Mental Health & Mental Retardation Current Accepting new patients
Northern Alabama Physicians, LLP Emergency Medicine Current Accepting new patients
Southland Hospitalist at Ozark, PL Emergency Medicine CurrentSince Oct 15, 2016 Accepting new patients
Hospital Physician Services - Southeast Professional Corporation CurrentSince Feb 12, 2015 Accepting new patients
Greater Mobile Urgent Care Current Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc CurrentSince Jul 7, 2015 Accepting new patients
Gmuc of Springhill LLC CurrentSince Aug 1, 2011 Accepting new patients
Northern Alabama Physicians, LLP CurrentSince Jan 1, 2016 Accepting new patients
Northern Alabama Physicians, LLP CurrentSince Jan 1, 2016 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Hospitalist Medicine Physicians of Louisiana, LLC Internal Medicine Past Accepting new patients
Mobile Emergency Group PC Emergency Medicine Past Accepting new patients

Locations

207 Haven Dr
Dothan, AL 36301
Phone (334) 793-1964

4370 W Main St
Dothan, AL 36305
Phone (256) 332-1611

2350 Schillinger Rd S
Ste A
Mobile, AL 36695
Phone (251) 633-0123

4402 Old Shell Rd
Mobile, AL 36608
Phone (251) 633-0123

725 E Coy Smith Hwy
Mount Vernon, AL 36560
Phone (251) 662-6700

126 Hospital Ave
Ozark, AL 36360
Phone (334) 445-4803

124 S Memorial Dr
Prattville, AL 36067
Phone (334) 361-4267

7943 Moffett Rd
Semmes, AL 36575
Phone (251) 445-7618

211 4th St
Alexandria, LA 71301
Phone (318) 473-3000

229 Saint John Ln
Covington, LA 70433
Phone (866) 875-9225

1111 N Causeway Blvd
Mandeville, LA 70471
Phone (985) 249-5600

555 E Cheves St
Florence, SC 29506
Phone (843) 662-5233

730 Stony Landing Rd
Ste 200
Moncks Corner, SC 29461
Phone (843) 567-3206

2000 Hospital Dr
Mt Pleasant, SC 29464
Phone (803) 533-2200

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
  • Direct secure messaging: nowoghomwenma.ibie@direct.davitaphysiciansolutions.com

Organizations & group practices 20

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.

View all 20

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": "1247443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488931200000",
    "number": "1073742953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 HAVEN DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363012919",
            "telephone_number": "334-793-3319",
            "fax_number": "334-793-2291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 HAVEN DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363012919",
            "telephone_number": "334-793-3319",
            "fax_number": "334-793-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBIE",
        "first_name": "NOWOGHOMWENMA",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-13",
        "last_updated": "2017-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "MD.30540",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "30540",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AL",
            "license": "MD.30540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE SOUTH",
            "identifier": "1073742953",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIVA HEALTH",
            "identifier": "Z14079",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "511-12500",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125314",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.