NPIMap

Individual provider Active NPI

Hisham Izzadin Ibrahim, M.D

  • Nephrology Physician
  • Winter Garden, FL
National Provider Identifier
1619918760
Registry record updated Mar 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
17166 Issued in NV
Practice address
1210 E Plant St Ste 120
Winter Garden, FL 34787-2995
Phone
(407) 297-8408
Fax
(407) 297-8408
NPI assigned
Jun 9, 2006
Last updated
Mar 25, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 17166 NV Primary

Addresses

Primary practice location

1210 E Plant St Ste 120
Winter Garden, FL 34787-2995

Mailing address

3333 E Camelback Rd
Ste 180
Phoenix, AZ 85018-2396
Phone (602) 759-6883

Other practice location 1

2545 S Bruce St Ste 200
Las Vegas, NV 89169-1778
Phone (702) 732-2438

Other practice location 2

1600 SW Archer Rd
Department of of Nephrology
Gainesville, FL 32610-0224
Phone (352) 273-8821

Other identifiers 2

IdentifierTypeStateIssuer
ME114722OtherFLLICENSE
1619918760MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20130213000294 FL Practitioner - NephrologyPractitioner - Internal MedicinePractitioner - Infectious Disease 2062497217 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1600 SW Archer
Gainesville, FL 32610-3003

1600 SW Archer Rd
Gainesville, FL 32610-3003

1600 SW Archer Rd RM
1191 Uf Health Surgical Specialists Shands
Gainesville, FL 32610-3003
Phone (352) 265-0535

2000 SW Archer Rd
Uf Health Congenital Heart Center Medical P
Gainesville, FL 32610-3003
Phone (352) 265-8250

2001 SW 13TH St
Gainesville, FL 32608-1532
Phone (352) 265-8990

Uf Health Test Site Pop Up 1600 SW Ar
Gainesville, FL 32610-3003
Phone (352) 392-1161

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
47.54 of 100Reported as apm
Quality
38.49
Promoting interoperability
0
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17166NVMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Nexis Healthcare, Inc. Past Accepting new patients
Onyx Medical & Wellness Center LLC Nephrology PastSince Jan 1, 2025 Accepting new patients
Obstetricians & Gynecologists, P.C. Past Accepting new patients

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: hibrahim406132@direct.shands.ufl.edu
  • Direct secure messaging: hibrahim66439@direct.umcsn.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/CCEJBD

Organizations & group practices 4

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 10

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": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585094400000",
    "number": "1619918760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 E CAMELBACK RD",
            "address_2": "STE 180",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182396",
            "telephone_number": "602-759-6883",
            "fax_number": "602-224-3315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 E PLANT ST STE 120",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347872995",
            "telephone_number": "407-297-8408",
            "fax_number": "407-297-8408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2545 S Bruce St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891691778",
            "country_code": "US",
            "telephone_number": "702-732-2438",
            "fax_number": "702-733-7876",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 SW Archer Rd",
            "address_2": "Department of of Nephrology",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326100224",
            "country_code": "US",
            "telephone_number": "352-273-8821",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "HISHAM",
        "middle_name": "IZZADIN",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NV",
            "license": "17166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "ME114722",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619918760",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Garden, FL

Sources for this page

Verify at the official NPI Registry.