NPIMap

Individual provider Active NPI

Waddah Ahdab, MD

  • Internal Medicine Physician
  • Highland, IN
National Provider Identifier
1255388286
Registry record updated Mar 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01046859A Issued in IN
Practice address
9696 Gordon Dr
Highland, IN 46322-2909
Phone
(219) 937-2511
Fax
(219) 937-2522
NPI assigned
May 27, 2006
Last updated
Mar 17, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01046859A IN Primary

Addresses

Primary practice location

9696 Gordon Dr
Highland, IN 46322-2909

Mailing address

9696 Gordon Dr
Highland, IN 46322-2909
Phone (219) 937-2511

Other identifiers 2

IdentifierTypeStateIssuer
200135920BMedicaidIN
036088188MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address waddahahdab@direct.practicefusion.com

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
I20100909001183 IN Practitioner - Internal Medicine 6709866320 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Illinois Medical College, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Columbia Medical Center LTDGroup PAC ID 7618957226, 6 clinicians

Practice addresses (Care Compare)

9696 Gordon Dr
Highland, IN 46322-2909
Phone (219) 937-2511

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01046859AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Medical Center LTD Internal Medicine CurrentSince Oct 1, 1998 Accepting new patients
Northwest Indiana Id Associates PC Current Accepting new patients
Northern Indiana Emergency Physicians, LLP Past Accepting new patients

Locations

9696 Gordon Dr
Highland, IN 46322
Phone (219) 937-2511

740 Seberger Dr
Munster, IN 46321
Phone (219) 237-6474

Interoperability endpoints

  • Direct secure messaging: wahdab64095@direct.franciscanalliance.org

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.

Hospital & facility affiliations 4

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": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1255388286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9696 GORDON DR",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463222909",
            "telephone_number": "219-937-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9696 GORDON DR",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463222909",
            "telephone_number": "219-937-2511",
            "fax_number": "219-937-2522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHDAB",
        "first_name": "WADDAH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01046859A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200135920B",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036088188",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "waddahahdab@direct.practicefusion.com",
            "affiliation": "N",
            "address_1": "9696 Gordon Dr",
            "city": "Highland",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463222909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Highland, IN

Sources for this page

Verify at the official NPI Registry.