Ahmed Mohsin Ibn-Mahfoudh, MD
Individual provider Active NPI Hospitalist Physician · Summit, WI
NPI 1457320970 · NPPES record last updated Jun 19, 2023
Key facts
- NPI
- 1457320970
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hospitalist Physician 208M00000X
- License
- 69542 (WI)
- Practice address
- 36500 Aurora Dr
Summit, WI 53066-4899 - Phone
- (262) 434-1000
- NPI assigned
- Mar 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 32
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Hospitalist
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aurora Medical Group, Inc.
Agnesian Healthcare Inc
Practice addresses (Care Compare)
36500 Aurora Dr
Summit, WI 53066-4899
Phone (262) 434-5000
430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 929-2300
Hospital & facility affiliations
- Aurora Medical Center Kenosha
- SSM Health St Agnes Hospital-Fond Du Lac
- Ripon Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051222000280 | NC | Practitioner - Internal Medicine | 8820019946 | Reassigns benefits to 2 organizations |
| I20180810000540 | WI | Practitioner - Hospitalist |
8820019946 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 69542 | WI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agnesian Healthcare Inc | Current |
Accepting new patients | |
| Baycare Aurora, LLC | Hospitalist | Current |
Accepting new patients |
| Aurora Medical Group, Inc. | Internal Medicine | Current |
Accepting new patients |
| Hospitalist Medicine Physicians of North Carolina PLLC | Internal Medicine | Current |
Accepting new patients |
| Hospitalist Medicine Physicians of North Carolina - Rocky Mount | Internal Medicine | Current |
Accepting new patients |
| Lakeshore Medical Clinic LTD | Current |
Accepting new patients | |
| Agnesian Healthcare Inc | Internal Medicine | Current |
Accepting new patients |
| Ahmed Ibn-Mahfoudh | Internal Medicine | Current | Accepting new patients |
| Agnesian Healthcare, Inc | Current | Accepting new patients | |
| Aurora Advanced Healthcare, Inc. | Internal Medicine | Current |
Accepting new patients |
| Lakeshore Medical Clinic, LLC | Current |
Accepting new patients | |
| Cogent Healthcare of North Carolina, PC | Internal Medicine | Current |
Accepting new patients |
| Aurora Medical Group, Inc. | Current |
Accepting new patients | |
| Aurora Advanced Healthcare Inc | Current |
Accepting new patients | |
| Premier Health Center Internal Medicine and Palliative Care Service | Past | Accepting new patients | |
| Prohealth Medical Group Inc | Internal Medicine | Past | Accepting new patients |
| Primedoc of Randolph County PA | Internal Medicine | Past | Accepting new patients |
Locations
1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000
409 Wake Chapel Rd
Fuquay Varina, NC 27526
Phone (919) 567-9001
2460 Curtis Ellis Dr
Rocky Mount, NC 27804
Phone (252) 443-8199
5410 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 377-1674
420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400
430 E Division St
Fond du Lac, WI 54935
Phone (920) 926-4200
3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100
2253 W Mason St
Green Bay, WI 54303
Phone (920) 327-7000
2845 Greenbrier Rd
Green Bay, WI 54311
Phone (920) 288-3388
1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497
360 S Mountin Dr
Mayville, WI 53050
Phone (920) 387-2111
12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200
1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056
S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747
845 Parkside St
Ripon, WI 54971
Phone (920) 748-3101
2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880
36500 Aurora Dr
Summit, WI 53066
Phone (262) 434-1000
791 Summit Ave
Summit, WI 53066
Phone (262) 569-0251
125 Hospital Dr
Watertown, WI 53098
Phone (920) 261-4210
725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011
620 W Brown St
Waupun, WI 53963
Phone (920) 324-5581
Interoperability endpoints
- aibnmahfoudh330044@direct-ehr-ssmhc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 69542 | WI | |
| Internal Medicine Physician | 207R00000X | 200100893 | NC | |
| Hospitalist Physician | 208M00000X | 69542 | WI | Yes |
Addresses
Primary practice location
36500 Aurora Dr
Summit, WI 53066-4899
Mailing address
PO Box 735044
Chicago, IL 60673-5044
Other practice location 1
409 Wake Chapel Rd
Fuquay Varina, NC 27526
Phone (919) 567-9001
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100079429 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | aibnmahfoudh330044@direct-ehr-ssmhc.com | Direct | AGNESIAN HEALTHCARE INC |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other | AGNESIAN HEALTHCARE INC |
| Direct Messaging Address | aibnmahfoudh307930@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
Other providers in Summit, WI
- Megan R Hoyer
- Beth A Hultman
- Steven J Hunter
- Abbey Hurtis
- Rachel Hyland
- Kimberly Couture Ireland
- Ahmed Ismail
- Zachary A Jaffa
- Jennifer Lynn Johnson
- Jessy Charles-James Johnson
All providers in Summit, WI · Hospitalist Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.