Candace Ibrahim

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

26NJ00911600 Issued in NJ

Practice address

22 Gordon Ave
Lawrenceville, NJ 08648-1033

Phone

(609) 844-0452

NPI assigned

Mar 21, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Princeton House Provider Group LLC

  • Psychiatry Physician
  • Princeton, NJ
  • NPI 1881078681
  Medicare reassignment NPD
• Compassionate Care Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Lawrenceville, NJ
  • NPI 1376473702
  NPD Authorized official
• Princeton Healthcare Affiliated Physicians PC

  • Internal Medicine Physician
  • Princeton, NJ
  • NPI 1770176372
  NPD (past)
• Princeton Healthcare System, a New Jersey Non-Profit Corporation

  • Psychiatric Hospital Unit
  • Princeton, NJ
  • NPI 1518009588
  NPD (past)

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

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1548720055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 LAUREL DR",
            "city": "WRIGHTSTOWN",
            "state": "NJ",
            "postal_code": "085622015",
            "telephone_number": "609-752-2357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 GORDON AVE",
            "city": "LAWRENCEVILLE",
            "state": "NJ",
            "postal_code": "086481033",
            "telephone_number": "609-844-0452"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1315 Whitehorse Mercerville Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "NJ",
            "postal_code": "086193815",
            "country_code": "US",
            "telephone_number": "609-581-5910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "CANDACE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-21",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "26NJ00911600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanna Hummel
• Arif Syed Hussain, MD
• Saleha Hussain, M.D.
• Miranda Hyatt
• I Smile Lawrenceville PC
• Darmakusuma Ie, M.D.
• Beatrice Iloka, APN
• Imagine Advanced Dental Arts PA
• Immeasurably More Counseling, LLC
• David Immerman, LCSW

• Psychiatry Physician in Lawrenceville, NJ
• Providers in Lawrenceville, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.