Active NPI
Ihtesham-Ur Syed Rahman
- Neurology Physician
- Midland, MI
National Provider Identifier
1386999639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 76367
- Practice address
- 4000 Wellness Dr
Midland, MI 48670-3621 - Phone
- (989) 839-3894
- NPI assigned
- Jul 23, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036141016 | IL | |
| Internal Medicine Physician | 207R00000X | 252141 | MA | |
| Neurology Physician | 2084N0400X | 76367 | WI | Primary |
| Neurology Physician | 2084N0400X | 4301116556 | MI |
Addresses
Primary practice location
4000 Wellness Dr
Midland, MI 48670-3621
Mailing address
725 American Ave
Waukesha, WI 53188-5031
Phone (262) 928-1000
Other practice location 1
725 North St
Pittsfield, MA 01201-4109
Phone (413) 447-2839
Other practice location 2
750 E Terra Cotta Ave
Crystal Lake, IL 60014-3621
Phone (815) 338-6600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Neurology
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
725 American Ave
Waukesha, WI 53188-5031
Phone (262) 928-1000
Hospital & facility affiliations
- Waukesha Memorial Hospital
- Oconomowoc Memorial Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 252141 | MA | MD | Internal Medicine Physician |
| 76367 | WI | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prohealth Medical Group Inc | Internal Medicine | Current | Accepting new patients |
| Prohealth Medical Group Inc. | Internal Medicine | Current | Accepting new patients |
| Prohealth Medical Group Inc | Internal Medicine | Past | Accepting new patients |
Locations
791 Summit Ave
Summit, WI 53066
Phone (262) 569-0251
725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011
N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093
N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030
Interoperability endpoints
- irahman156137@direct.phci.org
Organizations & group practices 3
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.
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Oconomowoc, WI
- NPI 1366420531
-
- Community/Retail Pharmacy
- Oconomowoc, WI
- NPI 1497942205
Hospital
-
- General Acute Care Hospital
- Waukesha, WI
- NPI 1629056890
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639094400000",
"number": "1386999639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "725 AMERICAN AVE",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531885031",
"telephone_number": "262-928-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 WELLNESS DR",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486703621",
"telephone_number": "989-839-3894"
}
],
"practiceLocations": [
{
"address_1": "725 North St",
"address_purpose": "LOCATION",
"city": "Pittsfield",
"state": "MA",
"postal_code": "012014109",
"country_code": "US",
"telephone_number": "413-447-2839",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "750 E Terra Cotta Ave",
"address_purpose": "LOCATION",
"city": "Crystal Lake",
"state": "IL",
"postal_code": "600143621",
"country_code": "US",
"telephone_number": "815-338-6600",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RAHMAN",
"first_name": "IHTESHAM-UR",
"middle_name": "SYED",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-23",
"last_updated": "2021-12-10",
"certification_date": "2021-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036141016",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "252141",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "WI",
"license": "76367",
"primary": true
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MI",
"license": "4301116556",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; 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.