NPIMap

Individual provider Active NPI

Shariq M Ibrahim, MD

  • Interventional Pain Medicine Physician
  • Munster, IN
National Provider Identifier
1245336486
Registry record updated Apr 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
01062605A Issued in IN
Practice address
8317 Calumet Ave
Munster, IN 46321-1737
Phone
(219) 513-2333
Fax
(219) 513-2333
NPI assigned
Sep 15, 2006
Last updated
Apr 30, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 01062605A IN
Pain Medicine (Anesthesiology) Physician 207LP2900X 01062605A IN
Interventional Pain Medicine Physician 208VP0014X 01062605A IN Primary

Addresses

Primary practice location

8317 Calumet Ave
Munster, IN 46321-1737

Mailing address

8317 Calumet Ave
Munster, IN 46321-1737
Phone (219) 513-2333

Other identifiers 4

IdentifierTypeStateIssuer
000000494372OtherINANTHEM BCBS
7163911OtherINAETNA
200859300MedicaidIN
000000573813OtherINANTHEM BC/BS OF INDIANA

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
I20070226000085 IN Practitioner - Interventional Pain ManagementPractitioner - Anesthesiology 6204938061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain ManagementAlso: Anesthesiology
Education
University of Missouri, Columbia School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Network IncGroup PAC ID 3678737012, 378 clinicians

Practice addresses (Care Compare)

800 Macarthur Blvd
Suite 28
Munster, IN 46321-2917
Phone (219) 440-5290

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Munster Primary Care PC Past Accepting new patients
Dylan Slotar MD PC PastSince Jul 1, 2012 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: sibrahim11232@ssdirect.comhs.org

Organizations & group practices 4

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 5

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": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398816000000",
    "number": "1245336486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8317 CALUMET AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463211737",
            "telephone_number": "219-513-2333",
            "fax_number": "219-513-2333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8317 CALUMET AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463211737",
            "telephone_number": "219-513-2333",
            "fax_number": "219-513-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "SHARIQ",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2014-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "01062605A",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IN",
            "license": "01062605A",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IN",
            "license": "01062605A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000494372",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7163911",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200859300",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS OF INDIANA",
            "identifier": "000000573813",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

Verify at the official NPI Registry.