Individual provider Active NPI

Ibrahim A Thabet, NP

  • Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1700189552
Registry record updated Aug 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
336367 Issued in NY
Practice address
750 E Adams St
Regional Oncology Center
Syracuse, NY 13210-2342
Phone
(315) 464-8200
Fax
(315) 464-8206
NPI assigned
Dec 17, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 336367 NY Primary

Addresses

Primary practice location

750 E Adams St
Regional Oncology Center
Syracuse, NY 13210-2342

Mailing address

750 E Adams St
Regional Oncology Center
Syracuse, NY 13210-2342
Phone (315) 464-8200

Other identifiers 1

IdentifierTypeStateIssuer
03299685MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130311000081 NY Practitioner - Nurse Practitioner 9537314992 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

Practice addresses (Care Compare)

301 Prospect Ave
Syracuse, NY 13203-1807
Phone (315) 448-5111

5100 W Taft Rd
Liverpool, NY 13088-4841

750 E Adams St
Syracuse, NY 13210-2306
Phone (315) 464-4457

Hospital & facility affiliations

  • University Hospital S U N Y Health Science Center Hospital, Syracuse, NY, CCN 330241
  • St Joseph'S Hospital Health Center Hospital, Syracuse, NY, CCN 330140

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Medicine Medical Service Group CurrentSince Jan 2, 2012 Accepting new patients
Department of Medicine Medical Serv GRP at Suny HLTH Sci Ctr Syr in CurrentSince Jan 2, 2012 Accepting new patients
St. Joseph'S Physician Health, P.C. CurrentSince Nov 21, 2014 Accepting new patients
Wellnow Urgent Care, PC CurrentSince Jul 1, 2018 Accepting new patients
St Josephs Medical PC CurrentSince Oct 6, 2018 Accepting new patients

Locations

6870 E Genesee St
Fayetteville, NY 13066
Phone (315) 679-4367

7375 Oswego Rd
#1
Liverpool, NY 13090
Phone (315) 291-0064

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

104 Union Ave
Syracuse, NY 13203
Phone (315) 422-4442

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

251 Salina Meadows Pkwy
Ste 100
Syracuse, NY 13212
Phone (315) 464-2000

Interoperability endpoints

  • Direct secure messaging: ithabet2387222@direct.trinity-health.org
  • Direct secure messaging: ithabet9707@direct.upstate.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1292544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377216000000",
    "number": "1700189552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "address_2": "REGIONAL ONCOLOGY CENTER",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102342",
            "telephone_number": "315-464-8200",
            "fax_number": "315-464-8206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "address_2": "REGIONAL ONCOLOGY CENTER",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102342",
            "telephone_number": "315-464-8200",
            "fax_number": "315-464-8206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THABET",
        "first_name": "IBRAHIM",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-17",
        "last_updated": "2013-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "336367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03299685",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.