Samuel Assad Amin Ibrahim, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

35.121784 Issued in OH

Practice address

79180 Corporate Center Dr
Ste 101
La Quinta, CA 92253-7235

Phone

(760) 837-7910

Fax

(760) 837-7920

NPI assigned

Apr 22, 2008

Sex

Male

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 CA

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

General Surgery

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Eisenhower Medical Center Hospital, Rancho Mirage, CA, CCN 050573
• John F Kennedy Memorial Hospital Hospital, Indio, CA, CCN 050534

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: samuelibrahimmd.samuelibrahim@134754.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Samuel Ibrahim, MD, Inc

  • Surgery Physician
  • La Quinta, CA
  • NPI 1184081432

  Neurological Surgery

  Medicare reassignment NPD Authorized official
• Eisenhower Medical Center

  dba Eisenhower Health

  • General Acute Care Hospital
  • Rancho Mirage, CA
  • NPI 1013981554
  NPD (past)
• JFK Memorial Hospital, Inc.

  dba John F. Kennedy Memorial Hospital

  • General Acute Care Hospital
  • Indio, CA
  • NPI 1477584993
  NPD (past)
• Camden Clark Memorial Hospital Corporation

  dba Camden Clark Medical Center

  • General Acute Care Hospital
  • Parkersburg, WV
  • NPI 1699704254
  NPD (past)
• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  NPD (past)

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

• Eisenhower Medical Center

  dba Eisenhower Health

  • General Acute Care Hospital
  • Rancho Mirage, CA
  • NPI 1013981554
  Care Compare affiliation
• JFK Memorial Hospital, Inc.

  dba John F. Kennedy Memorial Hospital

  • General Acute Care Hospital
  • Indio, CA
  • NPI 1477584993
  Care Compare affiliation

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460937600000",
    "number": "1326212358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79180 CORPORATE CENTER DR",
            "address_2": "STE 101",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922537235",
            "telephone_number": "760-837-7910",
            "fax_number": "760-837-7920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79180 CORPORATE CENTER DR",
            "address_2": "STE 101",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922537235",
            "telephone_number": "760-837-7910",
            "fax_number": "760-837-7920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "SAMUEL",
        "middle_name": "ASSAD AMIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-22",
        "last_updated": "2016-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35.121784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Powen Hsueh, D.O.
• Jung Eun Huh, DDS
• Huq DDS Inc (Jeffeson Dental)
• Gilbert Lawrence Hyde, M.D.
• Christopher Ibrahim, DO
• Incontinence Technologies, Inc.
• Hugh E Irwin, RPH
• J Darcy Dill DC
• Jaime Rojas, DDS, Inc.
• Maria Jaimes, RDAEF2

• Surgery Physician in La Quinta, CA
• Providers in La Quinta, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; 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.