NPIMap

Individual provider Active NPI

Bassem Bebawi Ibrahim, MD

  • Nephrology Physician
  • Mount Dora, FL
National Provider Identifier
1346683505
Registry record updated Jun 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME126737 Issued in FL
Practice address
18550 US Highway 441
Mount Dora, FL 32757
Phone
(352) 735-3755
Fax
(352) 385-0033
NPI assigned
Apr 8, 2013
Last updated
Jun 19, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X ME126737 FL
Nephrology Physician 207RN0300X ME126737 FL Primary

Addresses

Primary practice location

18550 US Highway 441
Mount Dora, FL 32757

Mailing address

18550 US Highway 441
Mount Dora, FL 32757-6751
Phone (352) 735-3755

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20180730000769 FL Practitioner - Nephrology 1759659451 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeview Healthcare System, LLCGroup PAC ID 8921074733, 25 clinicians

Practice addresses (Care Compare)

410 Fern Dr
Leesburg, FL 34748-7008
Phone (352) 812-8200

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeview Healthcare System, LLC CurrentSince Feb 12, 2023 Accepting new patients
Physicians of Central Florida PA Internal Medicine CurrentSince Jul 1, 2018 Accepting new patients
Lakeview Healthcare System, LLC Internal Medicine CurrentSince Feb 12, 2023 Accepting new patients
Physicians of Central Florida, LLC Internal Medicine CurrentSince Jul 1, 2018 Accepting new patients

Locations

410 Fern Dr
Leesburg, FL 34748
Phone (352) 218-8200

18550 US Highway 441
Mount Dora, FL 32757
Phone (352) 735-3755

10250 SE 167th Place Rd
Unit 5
Summerfield, FL 34491
Phone (352) 307-9225

1950 Laurel Manor Dr
Ste 150
The Villages, FL 32162
Phone (352) 633-5282

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: bibrahim563698@direct.shands.ufl.edu

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 9

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": "1365379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529366400000",
    "number": "1346683505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18550 US HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576751",
            "telephone_number": "352-735-3755",
            "fax_number": "352-385-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18550 US HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "32757",
            "telephone_number": "352-735-3755",
            "fax_number": "352-385-0033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "BASSEM",
        "middle_name": "BEBAWI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-08",
        "last_updated": "2018-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME126737",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME126737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Dora, FL

Sources for this page

Verify at the official NPI Registry.