Individual provider Active NPI

Ismaila Bello, MD

  • Cardiovascular Disease Physician
  • Brooklyn, NY
National Provider Identifier
1679803274
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
254882 Issued in NY
Practice address
450 Clarkson Ave
Brooklyn, NY 11203-2012
Phone
(678) 458-1686
Fax
(718) 630-3761
NPI assigned
Jan 4, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD216508 OR
Internal Medicine Physician 207R00000X 254882 NY
Cardiovascular Disease Physician 207RC0000X 1295 WI
Cardiovascular Disease Physician 207RC0000X 254882 NY Primary

Addresses

Primary practice location

450 Clarkson Ave
Brooklyn, NY 11203-2012

Mailing address

450 Clarkson Ave
Brooklyn, NY 11203-2012
Phone (678) 458-1686

Other practice location 1

1818 N Meade St
Appleton, WI 54911-3454
Phone (920) 731-8900

Other practice location 2

415 6TH St
Lewiston, ID 83501
Phone (208) 750-7507

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, IL, OR3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20141201000655 NY Practitioner - Cardiovascular Disease (Cardiology) 8325360449 Reassigns benefits to 2 organizations
I20170123000328 IL Practitioner - Cardiac SurgeryPractitioner - Cardiovascular Disease (Cardiology) 8325360449 Reassigns benefits to 1 organization
I20230725001931 OR Practitioner - Internal Medicine 8325360449 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Westchester Medical Center Advanced Physician Services, PC Current Accepting new patients
CGH Medical Center CurrentSince Dec 12, 2016 Accepting new patients
Westchester Medical Center Advanced Physician Services PC CurrentSince Dec 15, 2018 Accepting new patients
CGH Medical Center Current Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
CGH Medical Center CurrentSince Dec 12, 2016 Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Jul 11, 2023 Accepting new patients

Locations

101 E Miller Rd
Sterling, IL 61081
Phone (815) 632-5285

100 E Lefevre Rd
Sterling, IL 61081
Phone (815) 625-0400

95 Grasslands Rd
Valhalla, NY 10595
Phone (914) 493-2961

1698 E McAndrews Rd
Ste 300
Medford, OR 97504
Phone (541) 732-7850

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

Interoperability endpoints

  • Direct secure messaging: ibello307681@direct.thedacare.org

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1262563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1679803274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032012",
            "telephone_number": "678-458-1686",
            "fax_number": "718-630-3761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032012",
            "telephone_number": "678-458-1686",
            "fax_number": "718-630-3761"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1818 N Meade St",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549113454",
            "country_code": "US",
            "telephone_number": "920-731-8900",
            "fax_number": "920-738-5369",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "415 6TH ST",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ID",
            "postal_code": "83501",
            "country_code": "US",
            "telephone_number": "208-750-7507",
            "fax_number": "208-750-7384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BELLO",
        "first_name": "ISMAILA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-04",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD216508",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "254882",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "1295",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "254882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.