Individual provider Active NPI

Patrick E Ifediba, M.D.

  • Internal Medicine Physician
  • Birmingham, AL
National Provider Identifier
1104862531
Registry record updated Apr 11, 2018
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.

Matched on NPI only. Confirm current status with the OIG exclusions search before relying on it.

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
00019014 Issued in AL
Practice address
1515 6TH Ave S
Birmingham, AL 35233-1601
Phone
(205) 930-3200
NPI assigned
Jun 22, 2006
Last updated
Apr 11, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
00019014ALMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Care Complete Medical Clinic(CCMC)LLC CurrentSince Jun 18, 2013 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.

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

Verify at the official NPI Registry.