NPIMap

Individual provider Active NPI

Ahmed F Al Jebawi, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Anderson, IN
National Provider Identifier
1306839030
Registry record updated May 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
01048401A Issued in IN
Practice address
141 W 22ND St Ste 210
Anderson, IN 46016-4389
Phone
(765) 646-8795
NPI assigned
Aug 29, 2005
Last updated
May 17, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 01048401A IN Primary

Addresses

Primary practice location

141 W 22ND St Ste 210
Anderson, IN 46016-4389

Mailing address

141 W 22ND St Ste 210
Anderson, IN 46016-4389

Other identifiers 1

IdentifierTypeStateIssuer
200184910AMedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ahmed.al.jebawi.1@7598.direct.athenahealth.com St. Vincent Medical Group, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20130409000267 IN Practitioner - EndocrinologyPractitioner - Internal Medicine 6709022114 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Vincent Medical Group IncGroup PAC ID 7012047640, 728 clinicians

Practice addresses (Care Compare)

141 W 22ND St
Anderson, IN 46016-4389

8433 Harcourt Rd
Suite 100
Indianapolis, IN 46260-2193
Phone (317) 583-7600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01048401AINMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Vincent Medical Group, Inc. CurrentSince Apr 1, 2013 Accepting new patients
St. Vincent Medical Group, Inc. Current Accepting new patients
St. Vincent Medical Group, Inc. CurrentSince Apr 1, 2013 Accepting new patients
Johnson Memorial Hospital Past Accepting new patients
Major Hospital Past Accepting new patients
St Vincent Medical Group Inc Past Accepting new patients

Locations

141 W 22nd St
Ste 210
Anderson, IN 46016
Phone (765) 646-8795

8433 Harcourt Rd
Ste 100
Indianapolis, IN 46260
Phone (317) 583-7702

Interoperability endpoints

  • Direct secure messaging: ahmed.al.jebawi.1@7598.direct.athenahealth.com

Organizations & group practices 6

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 8

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": "1125273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1306839030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W 22ND ST STE 210",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 W 22ND ST STE 210",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164389",
            "telephone_number": "765-646-8795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL JEBAWI",
        "first_name": "AHMED",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-29",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IN",
            "license": "01048401A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200184910A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ahmed.al.jebawi.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St. Vincent Medical Group, Inc.",
            "address_1": "141 W 22nd St Ste 210",
            "city": "Anderson",
            "state": "IN",
            "country_code": "US",
            "postal_code": "460164389",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Anderson, IN

Sources for this page

Verify at the official NPI Registry.