Individual provider Active NPI

Bukriya Othman Ibrahim, FNP

  • Family Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1801684998
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
356925 Issued in NY
Practice address
750 E Adams St
Syracuse, NY 13210-2306
Phone
(315) 464-5540
NPI assigned
Apr 28, 2025
Last updated
Jun 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 356925 NY Primary
Registered Nurse 163W00000X 787254 NY

Addresses

Primary practice location

750 E Adams St
Syracuse, NY 13210-2306

Mailing address

6273 Addison Loomis
Cicero, NY 13039-8685

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
I20250710000363 NY Practitioner - Nurse Practitioner 8022522127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

750 E Adams St
Syracuse, NY 13210-2306
Phone (315) 464-8093

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
787254NYMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Suny Health Science Center at Syracuse Family CurrentSince Jun 12, 2025 Accepting new patients
Suny Health Science Center at Syracuse CurrentSince Jun 12, 2025 Accepting new patients
Suny Health Science Center at Syracuse Past Accepting new patients

Locations

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

Interoperability endpoints

  • Direct secure messaging: bothman85821@direct.upstate.edu

Organizations & group practices 3

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 1

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": "1745798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1801684998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6273 ADDISON LOOMIS",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "130398685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "BUKRIYA",
        "middle_name": "OTHMAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-28",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "356925",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "787254",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.