NPIMap

Individual provider Active NPI

Imad Haddad, MD

  • Internal Medicine Physician
  • Springfield, KY
National Provider Identifier
1508880063
Registry record updated Dec 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
37821 Issued in KY
Practice address
805 Bardstown Rd Ste 12
Springfield, KY 40069-1515
Phone
(859) 481-7113
Fax
(859) 481-7114
NPI assigned
Jul 27, 2006
Last updated
Dec 6, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 37821 KY Primary

Addresses

Primary practice location

805 Bardstown Rd Ste 12
Springfield, KY 40069-1515

Mailing address

805 Bardstown Rd Ste 12
Springfield, KY 40069-1515
Phone (859) 481-7113

Other identifiers 3

IdentifierTypeStateIssuer
000000316729OtherKYANTHEM
50005469OtherKYPASSPORT
64065865MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040305000033 KY Practitioner - Internal MedicinePractitioner - Emergency Medicine 5496643181 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stanford Wellcare Clinic PLLCGroup PAC ID 3375945785, 2 clinicians
24 On Physicians PCGroup PAC ID 5698688141, 274 clinicians
Family Wellcare Clinic PLLCGroup PAC ID 4688940240, 2 clinicians

Practice addresses (Care Compare)

132 Frontier Blvd
Suite 101
Stanford, KY 40484-8513

132 Frontier Blvd
Suite 101
Stanford, KY 40484-8663
Phone (606) 727-5757

217 S 3Rd St
Danville, KY 40422-1823
Phone (859) 239-5008

805 Bardstown Rd
Suite 12
Springfield, KY 40069-1515
Phone (859) 481-7113

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as group
Quality
77.5
Improvement activities
40
Cost
74.58

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Family Wellcare Clinic, PLLC Internal Medicine CurrentSince Sep 11, 2017 Accepting new patients
24 On Physicians, PC CurrentSince Aug 26, 2017 Accepting new patients
24 On Physicians, P.C. CurrentSince Aug 26, 2017 Accepting new patients
Stanford Wellcare Clinic PLLC Internal Medicine CurrentSince Jun 7, 2021 Accepting new patients
Medical Point of Care PLLC Past Accepting new patients
Springfield Health Center LLC Past Accepting new patients
Marshall Emergency Services Associates, PLLC Past Accepting new patients

Locations

217 S 3rd St
Danville, KY 40422
Phone (859) 239-1000

805 Bardstown Rd
Ste 12
Springfield, KY 40069
Phone (859) 481-7113

132 Frontier Blvd
Ste 101
Stanford, KY 40484
Phone (606) 727-5757

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FEJBBD

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family Wellcare Clinic PLLCSpringfield, KY, CCN 188974 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
W-2 Managing Employee (100%)
Operational/Managerial Control		 Jun 9, 2017
Jan 18, 2021
Jun 9, 2017
Stanford Wellcare Clinic PLLCStanford, KY, CCN B03923 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
W-2 Managing Employee (100%)
Operational/Managerial Control		 Jun 7, 2021
Jun 7, 2021
Jun 7, 2021

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512518400000",
    "number": "1508880063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 BARDSTOWN RD STE 12",
            "city": "SPRINGFIELD",
            "state": "KY",
            "postal_code": "400691515",
            "telephone_number": "859-481-7113",
            "fax_number": "859-481-7114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 BARDSTOWN RD STE 12",
            "city": "SPRINGFIELD",
            "state": "KY",
            "postal_code": "400691515",
            "telephone_number": "859-481-7113",
            "fax_number": "859-481-7114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDAD",
        "first_name": "IMAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2017-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "37821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000316729",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50005469",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64065865",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, KY

Sources for this page

Verify at the official NPI Registry.