NPIMap

Individual provider Active NPI

Ifeanyi O Isaiah, MD

  • Nephrology Physician
  • Pembroke Pines, FL
National Provider Identifier
1093936551
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME98154 Issued in FL
Practice address
17901 NW 5TH St
Suite 203
Pembroke Pines, FL 33029-2810
Phone
(954) 438-8085
Fax
(954) 438-8085
NPI assigned
May 1, 2007
Last updated
Feb 4, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME98154 FL Primary

Addresses

Primary practice location

17901 NW 5TH St
Suite 203
Pembroke Pines, FL 33029-2810

Mailing address

17901 NW 5TH St
Suite 203
Pembroke Pines, FL 33029-2810
Phone (954) 438-8085

Other identifiers 1

IdentifierTypeStateIssuer
ME 98154OtherFLMEDICAL LICENSE

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
I20070829000061 FL Practitioner - NephrologyPractitioner - Internal Medicine 7113991050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Temple University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

17901 NW 5TH St
Suite 203
Pembroke Pines, FL 33029-2810
Phone (954) 747-7017

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Living Stone Nephrology and Hypertension Consultants, Inc. Nephrology CurrentSince Jul 1, 2010 Accepting new patients
Living Stone Nephrology and Hypertension Consultants Inc Nephrology CurrentSince Jul 1, 2010 Accepting new patients

Locations

17325 NW 27th Ave
Ste 108
Miami Gardens, FL 33056
Phone (305) 627-5008

17901 NW 5th St
Ste 203
Pembroke Pines, FL 33029
Phone (954) 438-8085

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CDAABA/Endpoint/CDAABA
  • Direct secure messaging: ifeanyi.isaiah@lsn.eclinicaldirectplus.com

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 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580774400000",
    "number": "1093936551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17901 NW 5TH ST",
            "address_2": "SUITE 203",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330292810",
            "telephone_number": "954-438-8085",
            "fax_number": "954-438-8086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17901 NW 5TH ST",
            "address_2": "SUITE 203",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330292810",
            "telephone_number": "954-438-8085",
            "fax_number": "954-438-8085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISAIAH",
        "first_name": "IFEANYI",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME98154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME 98154",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.