NPIMap

Individual provider Active NPI

Mohammad Ibrahim, D.O

  • Family Medicine Physician
  • Montgomery, AL
National Provider Identifier
1295081198
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
125111 Issued in NY
Practice address
9304 Autumn Brooke Way
Montgomery, AL 36117-0943
Phone
(516) 305-1454
NPI assigned
Jul 28, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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 125111 NY Primary

Addresses

Primary practice location

9304 Autumn Brooke Way
Montgomery, AL 36117-0943

Mailing address

9304 Autumn Brooke Way
Montgomery, AL 36117-0943
Phone (516) 305-1454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20150914001263 AL Practitioner - Family Practice 0648587378 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Alabama Primary and Urgent Care AssociatesGroup PAC ID 6406277995, 3 clinicians

Practice addresses (Care Compare)

124 S Memorial Dr
Prattville, AL 36067-3619
Phone (334) 365-0551

645 McQueen Smith Rd N
Suite 210
Prattville, AL 36066-7269
Phone (334) 380-3714

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125111NYMDFamily Medicine Physician
1520ALMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Physician Services - Southeast Professional Corporation CurrentSince Sep 1, 2015 Accepting new patients
Central Alabama Primary and Urgent Care Associates Family Medicine CurrentSince May 11, 2020 Accepting new patients
The Health Care Authority for Baptist Health an Affiliate of Uabhs Past Accepting new patients

Locations

645 McQueen Smith Rd N
Ste 210
Prattville, AL 36066
Phone (334) 380-3714

124 S Memorial Dr
Prattville, AL 36067
Phone (334) 361-4267

645 McQueen Smith Rd N
Prattville, AL 36066
Phone (334) 361-7811

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 7

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": "1343433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589155200000",
    "number": "1295081198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9304 AUTUMN BROOKE WAY",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361170943",
            "telephone_number": "516-305-1454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9304 AUTUMN BROOKE WAY",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361170943",
            "telephone_number": "516-305-1454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MOHAMMAD",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-28",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "125111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

Verify at the official NPI Registry.