NPIMap

Individual provider Active NPI

Vivian Sami Ebrahim, M.D.

  • Gastroenterology Physician
  • Sulphur Springs, TX
National Provider Identifier
1073870440
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
R4961 Issued in TX
Practice address
1216 Church St
Sulphur Springs, TX 75482-2108
Phone
(903) 558-2222
Fax
(903) 558-2225
NPI assigned
Apr 23, 2012
Last updated
Jan 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X R4961 TX Primary

Addresses

Primary practice location

1216 Church St
Sulphur Springs, TX 75482-2108

Mailing address

1216 Church St
Sulphur Springs, TX 75482-2108
Phone (903) 558-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20180615000170 TX Practitioner - Gastroenterology 9739434747 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Texas Tech University Health Science Center School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Texas Modern GastroenterologyGroup PAC ID 7618381054, 3 clinicians

Practice addresses (Care Compare)

1216 Church St
Sulphur Springs, TX 75482-2108
Phone (903) 558-2222

1402 Medical Dr
Sulphur Springs, TX 75482-2199
Phone (903) 558-2222

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.35 of 100Reported as individual
Quality
90
Improvement activities
40
Cost
67.82

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy130
Upper gastrointestinal (GI) endoscopy for acid reflux129

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R4961TXMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SW Health LLC Current Accepting new patients
Texas Modern Gastroenterology Gastroenterology CurrentSince Jan 1, 2021 Accepting new patients

Locations

1216 Church St
Sulphur Springs, TX 75482
Phone (903) 558-2222

1402 Medical Dr
Sulphur Springs, TX 75482
Phone (903) 557-5661

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IJDDCD
  • FHIR API: https://fhir4.healow.com/fhir/r4/IJDDCD/Endpoint/IJDDCD

Organizations & group practices 2

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 6

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": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1073870440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 CHURCH ST",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754822108",
            "telephone_number": "903-558-2222",
            "fax_number": "903-558-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 CHURCH ST",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754822108",
            "telephone_number": "903-558-2222",
            "fax_number": "903-558-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBRAHIM",
        "first_name": "VIVIAN",
        "middle_name": "SAMI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-23",
        "last_updated": "2024-01-23",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TX",
            "license": "R4961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sulphur Springs, TX

Sources for this page

Verify at the official NPI Registry.