Organization Active NPI

Columbia Medical Center LTD

  • Internal Medicine Physician
  • Highland, IN
National Provider Identifier
1275588386
Registry record updated Dec 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
COLUMBIA MEDICAL CENTER LTD
Practice address
9696 Gordon Dr
Highland, IN 46322-2909
Phone
(219) 937-2511
Fax
(219) 937-2522
NPI assigned
May 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2012

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

Authorized official

Name
Dr. Waddah Ahdab, MDNPI 1255388286
Title
Owner
Phone
(219) 937-2511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 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 1

IdentifierTypeStateIssuer
200114330AMedicaidIN

Other names 1

  • Medical Associates of Highland Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040723000653 IN Part B Supplier - Clinic/Group Practice 7618957226 Receives reassigned benefits from 6 practitioners
Practice locations: Highland, IN; Munster, IN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D0959640Columbia Medical Center Dba Med Assoc of Highland9696 Gordon Dr, Highland, IN 46322Certificate of waiverApr 14, 2027

National Provider Directory

National Provider Directory

Locations

4320 Fir St
Unit 315
East Chicago, IN 46312
Phone (219) 392-2850

7400 Columbia Ave
Hammond, IN 46324
Phone (219) 803-4483

6414 Calumet Ave
Hammond, IN 46324
Phone (219) 595-9566

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

512 Ridge Rd
Munster, IN 46321

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1275588386",
    "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",
            "fax_number": "219-937-2522"
        },
        {
            "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": {
        "organization_name": "COLUMBIA MEDICAL CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2012-12-13",
        "status": "A",
        "authorized_official_last_name": "AHDAB",
        "authorized_official_first_name": "WADDAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-937-2511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200114330A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Associates of Highland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Highland, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.