NPIMap

Individual provider Active NPI

Imane Tiyal Bentahar, MD

  • Family Medicine Physician
  • East Bridgewater, MA
National Provider Identifier
1245488105
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
258525 Issued in MA
Practice address
1 Donald's Way Ste 210
East Bridgewater, MA 02333
Phone
(508) 350-2300
Fax
(508) 894-0412
NPI assigned
Sep 4, 2008
Last updated
Apr 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 258525 MA Primary

Addresses

Primary practice location

1 Donald's Way Ste 210
East Bridgewater, MA 02333

Mailing address

1 Compass Way
East Bridgewater, MA 02333-1465
Phone (781) 878-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20151019000755 MA Practitioner - Family Practice 9133297880 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Signature Healthcare Medical Group IncGroup PAC ID 7719876267, 250 clinicians

Practice addresses (Care Compare)

110 Liberty St
Brockton, MA 02301-5521
Phone (508) 894-0400

680 Centre St
Brockton, MA 02302-3308
Phone (508) 941-7000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince Sep 1, 2015 Accepting new patients
Compass Medical PC Family Medicine CurrentSince Apr 4, 2022 Accepting new patients
Steward Medical Group, Inc CurrentSince Sep 1, 2015 Accepting new patients
Signature Healthcare Medical Group Inc Family Medicine CurrentSince Jan 1, 2024 Accepting new patients
Steward Medical Group, Inc CurrentSince May 31, 2023 Accepting new patients
Compass Medical PC CurrentSince Apr 4, 2022 Accepting new patients
Mercy Care Management, Inc Family Medicine Past Accepting new patients

Locations

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

1 Pearl St
Ste 1400
Brockton, MA 02301
Phone (508) 897-6030

680 Centre St
Brockton, MA 02302
Phone (508) 941-7400

1 Donalds Way
Ste 210
East Bridgewater, MA 02333
Phone (508) 350-2300

1 Donalds Way
Ste 102
East Bridgewtr, MA 02333
Phone (508) 350-2100

362 N Bedford St
East Bridgewtr, MA 02333
Phone (508) 350-2350

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

8 Commerce Blvd
Middleboro, MA 02346
Phone (774) 260-9300

Interoperability endpoints

  • Direct secure messaging: imange.bentahar@direct.signature.masshiway.net

Organizations & group practices 7

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 6

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": "1220486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1245488105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 COMPASS WAY",
            "city": "EAST BRIDGEWATER",
            "state": "MA",
            "postal_code": "023331465",
            "telephone_number": "781-878-1700",
            "fax_number": "508-894-0412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 DONALD'S WAY STE 210",
            "city": "EAST BRIDGEWATER",
            "state": "MA",
            "postal_code": "02333",
            "telephone_number": "508-350-2300",
            "fax_number": "508-894-0412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENTAHAR",
        "first_name": "IMANE",
        "middle_name": "TIYAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-04",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "258525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Bridgewater, MA

Sources for this page

Verify at the official NPI Registry.