Active NPI
Patrick E Ifediba, M.D.
- Internal Medicine Physician
- Birmingham, AL
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Nov 18, 2021.
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 00019014
- Practice address
- 1515 6TH Ave S
Birmingham, AL 35233-1601 - Phone
- (205) 930-3200
- NPI assigned
- Jun 22, 2006
- Last updated
- Apr 11, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 00019014 | AL | Primary |
| Emergency Medicine Physician | 207P00000X | 00019014 | AL |
Addresses
Primary practice location
1515 6TH Ave S
Birmingham, AL 35233-1601
Mailing address
14050 NW 14TH St
Suite 190
Sunrise, FL 33323-2865
Phone (800) 424-3672
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00019014 | AL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Care Complete Medical Clinic(CCMC)LLC | Current | Accepting new patients | |
| Inphynet Contracting Services LLC | Emergency Medicine | Past | Accepting new patients |
| Paragon Contracting Services LLC | Emergency Medicine | Past | Accepting new patients |
Locations
1300 Bessemer Rd
Ste A
Birmingham, AL 35208
Phone (205) 929-0565
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.
-
- Primary Care Clinic/Center
- Birmingham, AL
- NPI 1750728846
-
- Emergency Medicine Physician
- Birmingham, AL
- NPI 1225071459
-
- Emergency Medicine Physician
- Delray Beach, FL
- NPI 1073556767
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523404800000",
"number": "1104862531",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14050 NW 14TH ST",
"address_2": "SUITE 190",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333232865",
"telephone_number": "800-424-3672",
"fax_number": "954-377-3042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 6TH AVE S",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352331601",
"telephone_number": "205-930-3200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IFEDIBA",
"first_name": "PATRICK",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2018-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AL",
"license": "00019014",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "AL",
"license": "00019014",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.