Idara John Edem, MD, MSC, FRCPC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

4301502929 Issued in MI

Practice address

4800 S Saginaw St Ste 1800
Flint, MI 48507-2677

Phone

(810) 732-8336

NPI assigned

Aug 22, 2019

Last updated

Sep 18, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 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

Neurosurgery

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jawad a Shah MD PCGroup PAC ID 5799779633, 89 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southeast Michigan Surgical Hospital LLC Hospital, Warren, MI, CCN 230264
• McLaren Flint Hospital, Flint, MI, CCN 230141

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: iedem1125954@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jawad a Shah, MD PC

  • Specialist
  • Flint, MI
  • NPI 1942402391

  Neurological Surgery

  Medicare reassignment Care Compare group NPD
• Jawad a Shah MD PC

  • Durable Medical Equipment & Medical Supplies
  • Dearborn, MI
  • NPI 1114667763
  NPD
• McLaren Flint

  • General Acute Care Hospital
  • Flint, MI
  • NPI 1902894512
  NPD (past)

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

• McLaren Flint

  • General Acute Care Hospital
  • Flint, MI
  • NPI 1902894512
  Care Compare affiliation
• Southeast Michigan Surgical Hospital, LLC

  dba Insight Surgical Hospital

  • General Acute Care Hospital
  • Warren, MI
  • NPI 1962402354
  Care Compare affiliation

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

{
    "created_epoch": "1566432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600387200000",
    "number": "1619524709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 S SAGINAW ST STE 1800",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485072677",
            "telephone_number": "810-732-8336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 S SAGINAW ST STE 1800",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485072677",
            "telephone_number": "810-732-8336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDEM",
        "first_name": "IDARA",
        "middle_name": "JOHN",
        "credential": "MD, MSC, FRCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-22",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MI",
            "license": "4301502929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "OneConnect",
            "affiliation": "N",
            "address_1": "1515 Holcombe Blvd",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770304000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sudesh J Ebenezer, MD, ED.M., FRCSC
• Nnenna Nwanyiriuba Eboda, BDS
• Shayhana Ebrahim, DMD
• Cindy Eckert
• Melvin Victor Eckles
• Eden Prairie Residential Care Services, LLC
• Sarah Edgerton
• Ashiya Edmond, BA, QMHP, QIDP
• Robert Keith Edmonds
• Edward Gomez-Seoane MD & Silvia Gomez-Seoane MD PC

• Neurological Surgery Physician in Flint, MI
• Providers in Flint, MI by specialty
• Neurological Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; 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.