Idris A Idris, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F01190538 Issued in AZ

Practice address

3515 W Union Hills Dr Ste 111
Glendale, AZ 85308-2430

Phone

(623) 328-8630

Fax

(623) 243-7842

NPI assigned

May 30, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Gadstar, P.C.

  • Family Medicine Physician
  • Glendale, AZ
  • NPI 1649719071
  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  AZ, Nurse Practitioner

  Medicare reassignment NPD

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1710545355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 W UNION HILLS DR STE 111",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853082430",
            "telephone_number": "623-328-8630",
            "fax_number": "623-243-7842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 W UNION HILLS DR STE 111",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853082430",
            "telephone_number": "623-328-8630",
            "fax_number": "623-243-7842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDRIS",
        "first_name": "IDRIS",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-30",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "F01190538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ibas LLC
• Raad Ibrahim
• Icare Family Health Services LLC
• Icare Health Services LLC
• Julia B Idemudia, NP-C
• Roberta Susan Ierley, PHARMD
• Camelia Igna
• Celina Ikam
• Ikmd PLLC
• Laura Ilardo, LCSW

• Family Nurse Practitioner in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.