Active NPI
Imad Albasha, MD
- Psychiatry Physician
- Rockford, IL
National Provider Identifier
1467584516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 036079335
- Practice address
- 1639 N Alpine Rd
Rockford, IL 61107-1449 - Phone
- (815) 229-7227
- Fax
- (815) 229-7288
- NPI assigned
- Mar 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 036079335 | IL | Primary |
Addresses
Primary practice location
1639 N Alpine Rd
Rockford, IL 61107-1449
Mailing address
1639 N Alpine Rd
Rockford, IL 61107-1449
Phone (815) 229-7227
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036079335 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036079335 | IL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210636800000",
"number": "1467584516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1639 N ALPINE RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611071449",
"telephone_number": "815-229-7227",
"fax_number": "815-229-7288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1639 N ALPINE RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611071449",
"telephone_number": "815-229-7227",
"fax_number": "815-229-7288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALBASHA",
"first_name": "IMAD",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-12",
"last_updated": "2008-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "036079335",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036079335",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.