Samir Gamal Ishak, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

01050654A Issued in IN

Practice address

500 W Votaw St
Portland, IN 47371-1322

Phone

(260) 418-7036

NPI assigned

Oct 5, 2005

Last updated

Feb 3, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Psychiatry

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeastern Center IncGroup PAC ID 6709795636, 24 clinicians

Sycamore Springs Physician Group LLCGroup PAC ID 2062634991, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parkview Dekalb Hospital Hospital, Auburn, IN, CCN 150045

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sishak1@direct.iuhealth.org

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.

• Northeastern Center Inc

  dba Northeastern Center

  • Community/Behavioral Health Agency
  • Kendallville, IN
  • NPI 1720140908
  Medicare reassignment Care Compare group NPD
• Sycamore Springs Physician Group LLC

  • Psychiatry Physician
  • Lafayette, IN
  • NPI 1972914539
  Medicare reassignment Care Compare group NPD
• Acute Behavioral Health Services, P.C.

  • Hospitalist Physician
  • Lafayette, IN
  • NPI 1700453388

  Psychiatry

  Medicare reassignment NPD
• Brentwood Meadows Physician Group LLC

  • Psychiatry Physician
  • Newburgh, IN
  • NPI 1528479029
  Medicare reassignment NPD
• Park Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fort Wayne, IN
  • NPI 1306897004
  Medicare reassignment NPD
• Parkview Health System Inc

  dba Parkview Physicians Group

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1932130952
  Medicare reassignment NPD
• St Joseph Medical Group Inc

  • General Practice Physician
  • Fort Wayne, IN
  • NPI 1811952070

  Psychiatry

  Medicare reassignment NPD
• Good Samaritan Mental Health Association LLC

  • Psychiatry Physician
  • Portland, IN
  • NPI 1154536704
  Authorized official Same address or phone
• Northeastern Center, Inc

  dba Northeastern Center Inpatient

  • Psychiatric Hospital
  • Auburn, IN
  • NPI 1689781346
  NPD
• Park Center Inc

  • Psychiatric Hospital
  • Fort Wayne, IN
  • NPI 1457772402
  NPD
• Parkview Health System, Inc.

  dba Parkview Physicians Group

  • Internal Medicine Physician
  • Fort Wayne, IN
  • NPI 1952411233
  NPD
• St Joseph Medical Group Inc

  • Family Medicine Physician
  • Angola, IN
  • NPI 1801851902
  NPD

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

• Dekalb Memorial Hospital, Inc

  dba Parkview Dekalb Hospital

  • General Acute Care Hospital
  • Auburn, IN
  • NPI 1902897937
  Care Compare affiliation

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1548257488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W VOTAW ST",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473711322",
            "telephone_number": "260-418-7036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISHAK",
        "first_name": "SAMIR",
        "middle_name": "GAMAL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01050654A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200490520",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000644855",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200490520A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SISHAK1@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "500 W Votaw St",
            "city": "Portland",
            "state": "IN",
            "country_code": "US",
            "postal_code": "473711322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tiffany L. Ickes, MHC
• Indiana University Health Jay, Inc.
• Indiana University Health Jay, Inc.
• Indiana University Health Jay, Inc.
• Indiana Vision Group, LLC (Elite Eye Care)
• Brian Ison, PTA
• Jay County Auditor Police Dept (Jay County Health Department)
• Jay County Government (Jay County Emergency Medical Service)
• Jay County Hospital
• Jay County Hospital (Jay Community Health Partners)

• Psychiatry Physician in Portland, IN
• Providers in Portland, IN by specialty
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.

Verify at the official NPI Registry.