Individual provider Active NPI

Ebla Dahir

  • Family Nurse Practitioner
  • Columbus, OH
National Provider Identifier
1366816134
Registry record updated Nov 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
COA-17059 Issued in OH
Practice address
3916 Roxham CT
Columbus, OH 43230-4518
Phone
(614) 596-2036
NPI assigned
Nov 17, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X COA-17059 OH Primary

Addresses

Primary practice location

3916 Roxham CT
Columbus, OH 43230-4518

Mailing address

3916 Roxham CT
Columbus, OH 43230-4518

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI, NY, IL, IN5 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
I20151215002630 OH Practitioner - Nurse Practitioner 4587965637 Reassigns benefits to 1 organization
I20211214000822 MI Practitioner - Nurse Practitioner 4587965637 Reassigns benefits to 1 organization
I20220406000238 NY Practitioner - Nurse Practitioner 4587965637 Reassigns benefits to 1 organization
I20220627001706 IL Practitioner - Nurse Practitioner 4587965637 Reassigns benefits to 1 organization
I20240412001408 IN Practitioner - Nurse Practitioner 4587965637 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
COA-17059OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pic Indiana PC CurrentSince May 20, 2024 Accepting new patients
Physicians Immediate Care North Chicago LLC CurrentSince Feb 7, 2023 Accepting new patients
Hometown Urgent Care of Michigan, P.C. Current Accepting new patients

Locations

121 W North Ave
Chicago, IL 60610
Phone (312) 643-5606

800 W Fulton Market
Fl 12
Chicago, IL 60607

4211 N Cicero Ave
Chicago, IL 60641
Phone (773) 794-1000

13448 Cicero Ave
Crestwood, IL 60418
Phone (708) 682-3384

3475 S Alpine Rd
Rockford, IL 61109
Phone (815) 874-8000

924 W Pike St
Goshen, IN 46526
Phone (574) 312-7056

1634 Gull Rd
Kalamazoo, MI 49048
Phone (269) 903-2835

Interoperability endpoints

  • Direct secure messaging: ebla.dahir.1@30520.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447718400000",
    "number": "1366816134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3916 ROXHAM CT",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432304518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3916 ROXHAM CT",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432304518",
            "telephone_number": "614-596-2036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHIR",
        "first_name": "EBLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-17",
        "last_updated": "2015-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA-17059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.