Mudasser Ibrahim, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

TRN20435 Issued in FL

Practice address

1657 Trinity Dr
Pensacola, FL 32504-5708

Phone

(850) 416-7710

NPI assigned

Jun 30, 2014

Last updated

Jun 30, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

University of Florida College of Medicine, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Memorial Hermann Hospital Based Physician Group

  • Emergency Medicine Physician
  • Houston, TX
  • NPI 1295363497
  Medicare reassignment NPD
• Florida State University

  • Children's Hospital
  • Pensacola, FL
  • NPI 1821244989
  NPD (past)
• Sacred Heart Health System, Inc.

  dba Ascension Medical Group Sacred Heart

  • Primary Care Clinic/Center
  • Pensacola, FL
  • NPI 1043261498
  NPD (past)

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

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404086400000",
    "number": "1306251228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5153 N 9TH AVE",
            "address_2": "6TH FLOOR NEMOURS",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048785",
            "telephone_number": "850-416-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1657 TRINITY DR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325045708",
            "telephone_number": "850-416-7710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MUDASSER",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-30",
        "last_updated": "2014-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "TRN20435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luke Auguste Hyder, MD
• Sayyada Hyder, MD
• Hygeia Medical Equipment, LLC
• Ian R Day, LLC
• Ias Billing Services Corporation
• Sherif Ibrahim, M.D.
• Roger D Iburg
• Ideal Optical Inc
• Mackenzie Keir Ikenberry, MS CGC
• Nada Samir Ilia, D.M.D.

• Pediatrics Physician in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.