NPIMap

Individual provider Active NPI

Mofid Khalil-Ibrahim, MD

  • Nuclear Cardiology Physician
  • Buffalo, NY
National Provider Identifier
1770645012
Registry record updated Apr 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nuclear Cardiology PhysicianTaxonomy code 207UN0901X
License
211652 Issued in NY
Practice address
3 Gates Cir
Buffalo, NY 14209-1120
Phone
(716) 887-4093
NPI assigned
Dec 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Cardiology Physician 207UN0901X 211652 NY Primary

Addresses

Primary practice location

3 Gates Cir
Buffalo, NY 14209-1120

Mailing address

3 Gates Cir
Buffalo, NY 14209-1120
Phone (716) 887-4600

Other identifiers 1

IdentifierTypeStateIssuer
01971897MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100323000850 NY Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Nuclear Medicine 7113913435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Nuclear Medicine
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
General Physician PCGroup PAC ID 9537213079, 488 clinicians

Practice addresses (Care Compare)

100 High St
Buffalo, NY 14203-1126
Phone (716) 859-1400

Hospital & facility affiliations

  • Kaleida Health Hospital, Buffalo, NY, CCN 330005
  • Erie County Medical Center Hospital, Buffalo, NY, CCN 330219
  • Olean General Hospital Hospital, Olean, NY, CCN 330103
  • Brooks-TLC Hospital System, Inc Hospital, Dunkirk, NY, CCN 330229

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
211652NYMDNuclear Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University at Buffalo Pathologists, Inc Current Accepting new patients
General Physician, PC CurrentSince Jun 6, 2017 Accepting new patients

Locations

875 Ellicott St
Buffalo, NY 14203
Phone (716) 748-2000

818 Ellicott St
Buffalo, NY 14203
Phone (716) 323-2000

100 High St
#B2
Buffalo, NY 14203
Phone (716) 859-1256

900 Hertel Ave
Buffalo, NY 14216
Phone (716) 871-1571

565 Abbott Rd
Buffalo, NY 14220
Phone (716) 826-7000

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

2121 Main St
Ste 100
Buffalo, NY 14214
Phone (716) 422-5422

100 High St
#13282
Buffalo, NY 14203

462 Grider St
Cheektowaga, NY 14215
Phone (716) 831-8612

3898 Vineyard Dr
Dunkirk, NY 14048
Phone (716) 363-1515

445 Tremont St
North Tonawanda, NY 14120
Phone (716) 690-2291

1540 Maple Rd
Williamsville, NY 14221
Phone (716) 568-3514

Organizations & group practices 2

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270771200000",
    "number": "1770645012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 GATES CIR",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142091120",
            "telephone_number": "716-887-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 GATES CIR",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142091120",
            "telephone_number": "716-887-4093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALIL-IBRAHIM",
        "first_name": "MOFID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2010-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "NY",
            "license": "211652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01971897",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.