Individual provider Active NPI

Ismail Tabash, MD

  • Interventional Cardiology Physician
  • Riverview, FL
National Provider Identifier
1700167640
Registry record updated Sep 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
036166773 Issued in IL
Practice address
13127 Vail Ridge Dr
Riverview, FL 33579-7196
Phone
(813) 661-3199
Fax
(813) 661-6334
NPI assigned
Sep 6, 2011
Last updated
Sep 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X R72859 AZ
Cardiovascular Disease Physician 207RC0000X 67458 WI
Cardiovascular Disease Physician 207RC0000X 036166773 IL
Interventional Cardiology Physician 207RI0011X ME156591 FL
Interventional Cardiology Physician 207RI0011X 036166773 IL Primary

Addresses

Primary practice location

13127 Vail Ridge Dr
Riverview, FL 33579-7196

Mailing address

13127 Vail Ridge Dr
Riverview, FL 33579-7196
Phone (813) 661-3199

Other practice location 1

14525 Bruce B Downs Blvd # 5
Tampa, FL 33613-2789
Phone (813) 661-6199

Other practice location 2

4051 Upper Creek Dr Ste 110
Sun City Center, FL 33573-6825
Phone (813) 661-6199

Other practice location 3

425 S Kings Ave
Brandon, FL 33511-5919
Phone (813) 661-6199

Other identifiers 1

IdentifierTypeStateIssuer
114619700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231007000698 IL Practitioner - Interventional Cardiology 8022309798 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

1405 W Park St
Urbana, IL 61801-2367
Phone (217) 337-3240

2200 E Washington St
Bloomington, IL 61701-4364
Phone (309) 662-3311

812 N Logan Ave
Danville, IL 61832-3752
Phone (217) 443-5000

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting33
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036166773ILMDCardiovascular Disease Physician
67458WIMDCardiovascular Disease Physician
R72859AZMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Saint James Hospital CurrentSince Nov 21, 2023 Accepting new patients
Saint James Hospital CurrentSince Nov 21, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Saint James Hospital Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Sep 25, 2023 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

210 Saint Joseph Dr
Bloomington, IL 61701
Phone (309) 663-5050

124 SW Adams St
Peoria, IL 61602
Phone (309) 655-2850

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

2500 W Reynolds St
Pontiac, IL 61764
Phone (815) 842-2828

2500 W Reynolds St
Ste 203205206207
Pontiac, IL 61764
Phone (815) 844-2001

Organizations & group practices 6

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 4

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": "1315267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695340800000",
    "number": "1700167640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13127 VAIL RIDGE DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335797196",
            "telephone_number": "813-661-3199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13127 VAIL RIDGE DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335797196",
            "telephone_number": "813-661-3199",
            "fax_number": "813-661-6334"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14525 Bruce B Downs Blvd # 5",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336132789",
            "country_code": "US",
            "telephone_number": "813-661-6199",
            "fax_number": "813-661-6334",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4051 Upper Creek Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Sun City Center",
            "state": "FL",
            "postal_code": "335736825",
            "country_code": "US",
            "telephone_number": "813-661-6199",
            "fax_number": "813-661-6334",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "425 S Kings Ave",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "FL",
            "postal_code": "335115919",
            "country_code": "US",
            "telephone_number": "813-661-6199",
            "fax_number": "813-661-6334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TABASH",
        "first_name": "ISMAIL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-06",
        "last_updated": "2023-09-22",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AZ",
            "license": "R72859",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "67458",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036166773",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "FL",
            "license": "ME156591",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "036166773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114619700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverview, FL

Sources for this page

Verify at the official NPI Registry.