Alicia Lynne Ibanez, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0010-03995 Issued in NC

Practice address

2131 Ayrsley Town Blvd
Suite 400
Charlotte, NC 28273-3595

Phone

(980) 297-7733

Fax

(980) 297-7744

NPI assigned

Dec 21, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alicia.ibanez@opmd.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optimed Hospitalists

  • Hospitalist Physician
  • Statesville, NC
  • NPI 1235449125
  Medicare reassignment
• Optimed Hospitalists

  • Internal Medicine Physician
  • Davidson, NC
  • NPI 1477942613
  NPD

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

{
    "created_epoch": "1356048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437350400000",
    "number": "1124364070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 CHANDELEUR DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175954",
            "telephone_number": "508-335-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 AYRSLEY TOWN BLVD",
            "address_2": "SUITE 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282733595",
            "telephone_number": "980-297-7733",
            "fax_number": "980-297-7744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBANEZ",
        "first_name": "ALICIA",
        "middle_name": "LYNNE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-21",
        "last_updated": "2015-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-03995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1570PA",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124364070",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8103056",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Iamhonored Inc
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• Iamlolaroe LTD. Liability Co.
• Alana Carolyn Iannello, BCBA
• Caylin Marie Iannotta, PA
• Adeima Ubokudom Ibanga
• Elena Gascon Ibe, M.D.
• Ikenna Chukwuemeka Ibe, MD
• Queenate Ibeto, DDS
• Shania Ibrahim, OTD, OTR/L

• Medical Physician Assistant in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.