NPIMap

Individual provider Active NPI

John Dean Ibrahim, M.D.

  • Family Medicine Physician
  • New Port Richey, FL
National Provider Identifier
1669555470
Registry record updated Jul 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME101502 Issued in FL
Practice address
8133 State Road 54
New Port Richey, FL 34655-3000
Phone
(727) 372-3750
Fax
(727) 372-3754
NPI assigned
Oct 23, 2006
Last updated
Jul 24, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME101502 FL Primary

Addresses

Primary practice location

8133 State Road 54
New Port Richey, FL 34655-3000

Mailing address

8133 State Road 54
New Port Richey, FL 34655-3000
Phone (727) 372-3750

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
I20081204000259 FL Practitioner - Family Practice 0648331082 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Health First Privia Medical GroupGroup PAC ID 3173965993, 247 clinicians
Sports and Orthopedic Rehabilitation Services IncGroup PAC ID 0840104253, shared by 4 NPIs, 314 clinicians

Practice addresses (Care Compare)

140 6TH Ave
Indialantic, FL 32903-3204
Phone (321) 312-3501

5347 Main St
Suite 202
New Port Richey, FL 34652-2520
Phone (727) 841-0515

989 Sebastian Blvd
Unit 3
Sebastian, FL 32958-4879
Phone (727) 617-1777

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME101502FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group Florida, LLC CurrentSince Feb 5, 2025 Accepting new patients
Trinity Doctors Group PA CurrentSince Aug 1, 2008 Accepting new patients
Major Hospital Past Accepting new patients

Locations

140 6th Ave
Indialantic, FL 32903
Phone (321) 312-3501

8133 State Road 54
New Prt Rchy, FL 34655
Phone (727) 372-3750

989 Sebastian Blvd
Unit 3
Sebastian, FL 32958
Phone (727) 617-1777

Interoperability endpoints

  • Direct secure messaging: john.ibrahim.1@8042.direct.athenahealth.com

Organizations & group practices 3

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 6

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": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1669555470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8133 STATE ROAD 54",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346553000",
            "telephone_number": "727-372-3750",
            "fax_number": "727-372-3754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8133 STATE ROAD 54",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346553000",
            "telephone_number": "727-372-3750",
            "fax_number": "727-372-3754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "JOHN",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME101502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Port Richey, FL

Sources for this page

Verify at the official NPI Registry.