NPIMap

Individual provider Active NPI

Miriam Lela Ibrahim, MD

  • Physical Medicine & Rehabilitation Physician
  • Muncie, IN
National Provider Identifier
1194768549
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
01047444A Issued in IN
Practice address
1107 S Tillotson Ave
Ste 1
Muncie, IN 47304-4517
Phone
(765) 213-3024
Fax
(765) 282-9303
NPI assigned
Jun 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 01047444A IN Primary

Addresses

Primary practice location

1107 S Tillotson Ave
Ste 1
Muncie, IN 47304-4517

Mailing address

PO Box 1889
Muncie, IN 47308-1889
Phone (765) 284-0493

Other identifiers 1

IdentifierTypeStateIssuer
20174740MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20100608000118 IN Practitioner - Pain ManagementPractitioner - Other (Physician)Practitioner - Physical Medicine and Rehabilitation 8123916442 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Physical Medicine and Rehabilitation
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Open Door Health Services Inc 40 clinicians
US Therapy Inc 81 clinicians

Practice addresses (Care Compare)

333 S Madison St
Muncie, IN 47305-2465
Phone 76528670004235

3607 N Everbrook LN
Muncie, IN 47304-5220

Hospital & facility affiliations

  • Indiana University Health Ball Memorial Hospital Hospital, Muncie, IN, CCN 150089

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01047444AINMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Open Door Health Services, Inc. CurrentSince Jul 1, 2020 Accepting new patients
Open Door Health Services, Inc. Current Accepting new patients
Open Door Health Services, Inc. CurrentSince Jul 1, 2020 Accepting new patients
Open Door Health Services, Inc. Past Accepting new patients
Open Door Health Services, Inc. Past Accepting new patients
Open Door Health Services, Inc. Past Accepting new patients
Central Indiana Physical Medicine & Rehab Physical Medicine & Rehabilitation PastSince Nov 1, 2002 Accepting new patients

Locations

333 S Madison St
Muncie, IN 47305
Phone (765) 287-3087

Interoperability endpoints

  • Direct secure messaging: miriam.ibrahim.1@10844.direct.athenahealth.com

Organizations & group practices 11

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.

Hospital & facility affiliations 1

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1194768549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1889",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473081889",
            "telephone_number": "765-284-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 S TILLOTSON AVE",
            "address_2": "STE 1",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473044517",
            "telephone_number": "765-213-3024",
            "fax_number": "765-282-9303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MIRIAM",
        "middle_name": "LELA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IN",
            "license": "01047444A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20174740",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muncie, IN

Sources for this page

Verify at the official NPI Registry.