Ayesha Mallick Imam, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35.144361 Issued in OH

Practice address

100 Medical Center Dr
Springfield, OH 45504-2687

Phone

(937) 523-4147

NPI assigned

Apr 24, 2013

Last updated

Nov 2, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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 OH

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

Internal Medicine

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Usacs Critical Care Medicine Services of Ohio, LLCGroup PAC ID 5991188286, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Springfield Regional Medical Center Hospital, Springfield, OH, CCN 360086
• Mercy Health - Urbana Hospital Hospital, Urbana, OH, CCN 361312
• Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360

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.

• Usacs Critical Care Medicine Services of Ohio, LLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Springfield, OH
  • NPI 1104560580
  Medicare reassignment Care Compare group NPD
• Usacs Integrated Acute Care Services of Ohio, LLC

  • Internal Medicine Physician
  • Springfield, OH
  • NPI 1043805690
  Medicare reassignment NPD
• Community Mercy Health Partners

  dba Mercy Health - Springfield Regional Medical Center

  • General Acute Care Hospital
  • Springfield, OH
  • NPI 1144286402
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Beavercreek Medical Center

  dba Soin Medical Center

  • General Acute Care Hospital
  • Beavercreek, OH
  • NPI 1760764849
  Care Compare affiliation
• Community Mercy Health Partners

  dba Mercy Health - Urbana Hospital

  • Critical Access Hospital
  • Urbana, OH
  • NPI 1144286352
  Care Compare affiliation
• Community Mercy Health Partners

  dba Mercy Health - Springfield Regional Medical Center

  • General Acute Care Hospital
  • Springfield, OH
  • NPI 1144286402
  Care Compare affiliation
• Community Mercy Health Partners

  dba Mercy Health - Lab Services, Springfield

  • Clinical Medical Laboratory
  • Springfield, OH
  • NPI 1477217297

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1366761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1306280094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 BERGEN STREET,",
            "address_2": "SUITE E-401",
            "city": "NEWARK,",
            "state": "NJ",
            "postal_code": "071011709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL CENTER DR",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455042687",
            "telephone_number": "937-523-4147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMAM",
        "first_name": "AYESHA MALLICK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-24",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.144361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rami Hussain, M.D
• Natalia Hyman
• Isabel Marie Hysing, RD
• John Anthony Ianni, D.D.S.
• Olajumoke Ayobami Ige, MD
• Impact City Church of Springfield (Impact Youth Services)
• Imtiaz Ahmed, M.D., LLC
• Farooq Imtiaz
• Independent Living of Ohio, Inc
• Heather Mechelle Innis, RN

• Internal Medicine Physician in Springfield, OH
• Providers in Springfield, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; 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.