NPIMap

Individual provider Active NPI

Ibrahim Al-Sanouri, MD

  • Pulmonary Disease Physician
  • Madison, WI
National Provider Identifier
1356452833
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
4301075451 Issued in MI
Practice address
700 S Park St
Madison, WI 53715-1830
Phone
(608) 251-6100
Fax
(608) 258-5222
NPI assigned
Aug 31, 2006
Last updated
Oct 27, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X 4301075454 MI
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 4301075454 MI
Pulmonary Disease Physician 207RP1001X 51402 WI
Pulmonary Disease Physician 207RP1001X 4301075451 MI Primary

Addresses

Primary practice location

700 S Park St
Madison, WI 53715-1830

Mailing address

G3252 Beecher Rd
Flint, MI 48532-3614
Phone (810) 230-6800

Other practice location 1

1836 South Ave
LA Crosse, WI 54601-5429
Phone (608) 782-7300

Other practice location 2

G3252 Beecher Rd
Flint, MI 48532-3614
Phone (810) 230-6800

Other identifiers 1

IdentifierTypeStateIssuer
1356452833MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ialsanouri337827@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040311001409 MI Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 2668361239 Reassigns benefits to 2 organizations
I20080527000265 WI Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 2668361239 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists)
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pulmonary Associates, PCGroup PAC ID 7719984194, 11 clinicians

Practice addresses (Care Compare)

1910 S Ave
La Crosse, WI 54601-5467
Phone (608) 782-7300

G3252 Beecher Rd
Flint, MI 48532-3614
Phone (810) 230-6800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301075454MIMDAllergy & Immunology Physician
51402WIMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Express Care, Inc CurrentSince Apr 14, 2014 Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Edward W Sparrow Hospital Association CurrentSince Oct 15, 2021 Accepting new patients
Gundersen Lutheran Medical Center Inc Allergy & Immunology CurrentSince Apr 14, 2014 Accepting new patients
Edward W Sparrow Hospital Association CurrentSince Oct 15, 2021 Accepting new patients
Pulmonary Associates, PC Pulmonary Disease CurrentSince Sep 1, 2018 Accepting new patients
Edward W. Sparrow Hospital Association Current Accepting new patients
Gundersen Clinic LTD CurrentSince Apr 14, 2014 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Apr 14, 2014 Accepting new patients
Mazen Sabbaq M.D. P.C. Past Accepting new patients
Allergy Immunology and Pulmonary Critical Care PC Pulmonary Disease Past Accepting new patients
Faith Regional Physician Services, LLC Critical Care Medicine PastSince Dec 28, 2015 Accepting new patients
Faith Regional Physician Services, LLC Past Accepting new patients
SJMH Medical Practice-SMHC Pulmonary Disease Past Accepting new patients
Hurley Medical Center Past Accepting new patients
McLaren Flint Past Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

G3252 Beecher Rd
Flint, MI 48532
Phone (810) 230-6800

8401 Holly Rd
Grand Blanc, MI 48439
Phone (810) 695-8011

1215 E Michigan Ave
Lansing, MI 48912
Phone (517) 336-8080

1215 E Michigan Ave
#C
Lansing, MI 48912
Phone (517) 364-2050

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681

Interoperability endpoints

  • Direct secure messaging: ialsanouri473177@direct.emplifyhealth.org
  • Direct secure messaging: ialsanouri944285@direct.hfhs.org
  • Direct secure messaging: ibrahimal-sanouri@papc.allscriptsdirect.net

Organizations & group practices 16

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.

View all 16

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1356452833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "G3252 BEECHER RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323614",
            "telephone_number": "810-230-6800",
            "fax_number": "810-230-0713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S PARK ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151830",
            "telephone_number": "608-251-6100",
            "fax_number": "608-258-5222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1836 South Ave",
            "address_purpose": "LOCATION",
            "city": "LA Crosse",
            "state": "WI",
            "postal_code": "546015429",
            "country_code": "US",
            "telephone_number": "608-782-7300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "G3252 BEECHER RD",
            "address_purpose": "LOCATION",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323614",
            "country_code": "US",
            "telephone_number": "810-230-6800",
            "fax_number": "810-230-0713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AL-SANOURI",
        "first_name": "IBRAHIM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "MI",
            "license": "4301075454",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MI",
            "license": "4301075454",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WI",
            "license": "51402",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MI",
            "license": "4301075451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356452833",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ialsanouri337827@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ialsanouri337827@direct-ehr-ssmhc.com",
            "address_1": "700 S Park St",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151830",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "700 S Park St",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.