Active NPI
Ibrahim T Beidari, CRNP
- Family Nurse Practitioner
- Harrisburg, PA
National Provider Identifier
1740636596
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Feb 20, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- SP016119
- Practice address
- 111 S Front St
Harrisburg, PA 17101-2010 - Phone
- (717) 782-3380
- Fax
- (717) 782-5716
- NPI assigned
- May 11, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | SP016119 | PA | Primary |
Addresses
Primary practice location
111 S Front St
Harrisburg, PA 17101-2010
Mailing address
409 S 2ND St Ste 2F
Harrisburg, PA 17104-1612
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103112700 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP016119 | PA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516665600000",
"number": "1740636596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "409 S 2ND ST STE 2F",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171041612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 S FRONT ST",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171012010",
"telephone_number": "717-782-3380",
"fax_number": "717-782-5716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEIDARI",
"first_name": "IBRAHIM",
"middle_name": "T",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-11",
"last_updated": "2018-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "PA",
"license": "SP016119",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103112700",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harrisburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.