Ibrahim J Haddad, MD

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

35-062494 Issued in OH

Practice address

7641 Market St Ste 3
Boardman, OH 44512

Phone

(330) 729-9140

NPI assigned

Mar 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH, KY2 enrollments

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 2

Specialty

Pediatric Medicine

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Triad Health Services LLCGroup PAC ID 9032367917, 252 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Surgical Hospital at Southwoods Hospital, Youngstown, OH, CCN 360352

Merit-based Incentive Payment System (MIPS)

Final score

83.94 of 100Reported as group

Quality

71.12

Promoting interoperability

100

Improvement activities

40

Cost

75.36

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Triad Health Services, LLC

  • Plastic Surgery Physician
  • Youngstown, OH
  • NPI 1588925457
  Medicare reassignment Care Compare group NPD
• Norton Children'S Medical Group, LLC

  • Psychiatry Physician
  • Louisville, KY
  • NPI 1457999096
  Medicare reassignment NPD
• Constantine G Economus MD LLC

  • Obstetrics & Gynecology Physician
  • Youngstown, OH
  • NPI 1366637217
  NPD
• Norton Children'S Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Louisville, KY
  • NPI 1265070809
  NPD
• Norton Children'S Medical Group, LLC

  • Pediatric Radiology Physician
  • Louisville, KY
  • NPI 1659913812
  NPD
• The Surgery Center at Southwoods, LLC

  • Special Hospital
  • Youngstown, OH
  • NPI 1740398890
  NPD (past)

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

• The Surgery Center at Southwoods, LLC

  • Special Hospital
  • Youngstown, OH
  • NPI 1740398890
  Care Compare affiliation

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557792000000",
    "number": "1366401960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3349",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445133349",
            "telephone_number": "330-729-9140",
            "fax_number": "330-729-9144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7641 MARKET ST STE 3",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "44512",
            "telephone_number": "330-729-9140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5333 Hollister Ave Ste 250",
            "address_purpose": "LOCATION",
            "city": "Goleta",
            "state": "CA",
            "postal_code": "93111",
            "country_code": "US",
            "telephone_number": "805-879-4242",
            "fax_number": "805-879-4268",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5333 Hollister Ave Ste 250",
            "address_purpose": "LOCATION",
            "city": "Goleta",
            "state": "CA",
            "postal_code": "93111",
            "country_code": "US",
            "telephone_number": "805-879-4242",
            "fax_number": "805-879-4268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HADDAD",
        "first_name": "IBRAHIM",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2019-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "PA",
            "license": "MD045935L",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "OH",
            "license": "35-062494",
            "primary": true
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "CA",
            "license": "A44109",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NM",
            "license": "MD2014-0041",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "OH",
            "license": "35062494H",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0860528",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01256834",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrizia Guerrieri, M.D.
• Jill Christine Gulling, APRN, CNP
• Prakash Gyawali, M.D.
• Jeffrey Adam Hackney, MD
• Anita Angela Hackstedde, M.D.
• Antonius Susatyo Hadi, MD
• Theresa Lynn Hahn, CNP
• Melissa Marie Haire, PA-C
• Jennifer Hake, CDCA
• Cynthia L Hale, CRNP

• Pediatric Gastroenterology Physician in Boardman, OH
• Providers in Boardman, OH by specialty
• Pediatric Gastroenterology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2019; 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.