NPIMap

Individual provider Active NPI

Isam Daboul, M.D.

  • Gastroenterology Physician
  • Oregon, OH
National Provider Identifier
1306820618
Registry record updated Jul 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
35079506 Issued in OH
Practice address
2702 Navarre Ave
Suite 106
Oregon, OH 43616-3223
Phone
(419) 383-3742
Fax
(419) 383-6244
NPI assigned
Nov 30, 2005
Last updated
Jul 11, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 35079506 OH Primary

Addresses

Primary practice location

2702 Navarre Ave
Suite 106
Oregon, OH 43616-3223

Mailing address

2702 Navarre Avenue
Oregon, OH 43616-3224
Phone (419) 696-5555

Other identifiers 1

IdentifierTypeStateIssuer
2250424MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20051121000046 OH Practitioner - Gastroenterology 1557354594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1360 Arrowhead Dr
Maumee, OH 43537-1728
Phone (419) 794-7880

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy184
Upper gastrointestinal (GI) endoscopy for acid reflux271

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35079506OHMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians North Specialty Care LLC CurrentSince Sep 1, 2021 Accepting new patients
M C Paneda PC Current Accepting new patients
Mercy Health Physicians North Specialty Care LLC CurrentSince Sep 1, 2021 Accepting new patients
University of Toledo Physicians LLC Internal Medicine Past Accepting new patients

Locations

1360 Arrowhead Dr
Maumee, OH 43537
Phone (419) 794-0001

2702 Navarre Ave
Ste 320
Oregon, OH 43616
Phone (419) 479-5795

12623 Eckel Junction Rd
Perrysburg, OH 43551
Phone (567) 368-1434

2213 Cherry St
Ste 305
Toledo, OH 43608
Phone (419) 321-3512

2222 Cherry St
Ste 2300
Toledo, OH 43608
Phone (419) 251-8013

3425 Executive Pkwy
Ste 210
Toledo, OH 43606
Phone (419) 251-2360

3900 Sunforest Ct
Ste 240
Toledo, OH 43623
Phone (419) 472-3126

725 S Shoop Ave
Wauseon, OH 43567
Phone (419) 335-2015

Interoperability endpoints

  • Direct secure messaging: idaboul50157@direct.bsmhealth.org

Organizations & group practices 4

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": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341964800000",
    "number": "1306820618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 NAVARRE AVENUE",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163224",
            "telephone_number": "419-696-5555",
            "fax_number": "419-696-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2702 NAVARRE AVE",
            "address_2": "SUITE 106",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163223",
            "telephone_number": "419-383-3742",
            "fax_number": "419-383-6244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DABOUL",
        "first_name": "ISAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2012-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OH",
            "license": "35079506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2250424",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oregon, OH

Sources for this page

Verify at the official NPI Registry.