Bahae Mohammed Ebrahem

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301089436 Issued in MI

Practice address

12815 Northline Rd
Southgate, MI 48195-1109

Phone

(734) 284-2090

NPI assigned

Aug 19, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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 1

Specialty

Internal MedicineAlso: Pediatric Medicine

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southgate Medical Center PLLCGroup PAC ID 2264688621, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Home Health Care Home health agency, Detroit, MI, CCN 237087
• Wyandotte Hospital and Medical Center Hospital, Wyandotte, MI, CCN 230146
• Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bebrahem221190@direct.hfhs.org

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.

• Southgate Medical Center PLLC

  • Internal Medicine Physician
  • Southgate, MI
  • NPI 1801155858
  Medicare reassignment Care Compare group NPD
• Hospitalist Physicians Medical Group of Michigan, PC

  • Emergency Medicine Physician
  • Chelsea, MI
  • NPI 1003978867
  Medicare reassignment NPD
• Hospitalist Physicians Medical Group of Michigan, PC

  • Emergency Medicine Physician
  • Saint Joseph, MI
  • NPI 1407618234
  NPD
• Henry Ford Wyandotte Hospital

  • General Acute Care Hospital
  • Wyandotte, MI
  • NPI 1992725352
  NPD (past)
• SJMH Medical Practice-SMHC

  • Internal Medicine Physician
  • Pontiac, MI
  • NPI 1346284684
  NPD (past)

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

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Care Compare affiliation
• Henry Ford Health System

  • Home Health Agency
  • Detroit, MI
  • NPI 1932162096
  Care Compare affiliation
• Henry Ford Wyandotte Hospital

  • Ambulatory Surgical Clinic/Center
  • Wyandotte, MI
  • NPI 1093901035

  Hospital

  Care Compare affiliation
• Henry Ford Wyandotte Hospital

  • General Acute Care Hospital
  • Wyandotte, MI
  • NPI 1992725352
  Care Compare affiliation

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

{
    "created_epoch": "1187481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365465600000",
    "number": "1508059072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12815 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951109",
            "telephone_number": "734-284-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12815 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951109",
            "telephone_number": "734-284-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBRAHEM",
        "first_name": "BAHAE",
        "middle_name": "MOHAMMED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-19",
        "last_updated": "2013-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301089436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105222450",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theodore Joseph Dziengelewski
• Serena Eagan, LMSW
• Eagle Drugs Inc
• East River Associates LLC
• Larry Clinton Eaton, P.T.
• Samantha Edmonds
• Meagan Edwards
• Michelle Edwards, LLP
• Robert L. Edwards, LMSW
• Timothy Patrick Egan Jr.

• Internal Medicine Physician in Southgate, MI
• Providers in Southgate, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; 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.