Individual provider Active NPI

Ireny I. Ibrahim, MD

  • Internal Medicine Physician
  • Colton, CA
National Provider Identifier
1811944598
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A64541 Issued in CA
Practice address
1300 E Cooley Dr
Colton, CA 92324-3905
Phone
(909) 370-4179
Fax
(909) 796-4158
NPI assigned
May 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A64541 CA Primary

Addresses

Primary practice location

1300 E Cooley Dr
Colton, CA 92324-3905

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Other identifiers 1

IdentifierTypeStateIssuer
00A645410MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100406000596 CA Practitioner - Internal Medicine 0244366854 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, Irvine, California College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beaver Medical Group P CGroup PAC ID 0547164295, 251 clinicians

Practice addresses (Care Compare)

1300 E Cooley Dr
Colton, CA 92324-3905
Phone (909) 370-4100

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healthcare Partners Affiliates Medical Group CurrentSince Jan 1, 2024 Accepting new patients
Cassidy Medical Group Inc. Current Accepting new patients
Healthcare Partners Affiliates Medical Group Internal Medicine CurrentSince Jan 1, 2024 Accepting new patients
Beaver Medical Group P C Internal Medicine CurrentSince Dec 27, 2009 Accepting new patients
Centers for Family Medicine GP Internal Medicine Current Accepting new patients
Beaver Medical Group P C CurrentSince Dec 27, 2009 Accepting new patients
Redlands Community Hospital Past Accepting new patients
Beaver Medical Group P C Internal Medicine Past Accepting new patients

Locations

1236 N Magnolia Ave
Anaheim, CA 92801
Phone (714) 995-1000

5957 W Ramsey St
Banning, CA 92220
Phone (951) 845-8864

2910 Jefferson St
Ste 100
Carlsbad, CA 92008
Phone (760) 729-8600

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

1300 E Cooley Dr
Colton, CA 92324
Phone (909) 370-4100

1615 Orange Tree Ln
Redlands, CA 92374
Phone (909) 335-4102

2 W Fern Ave
Redlands, CA 92373
Phone (909) 335-4137

2 W Fern Ave
#1112
Redlands, CA 92373

1700 N Waterman Ave
Sn Bernrdno, CA 92404
Phone (909) 883-8611

145 Thunder Dr
Vista, CA 92083
Phone (760) 630-5487

145 Thunder Dr
#1182
Vista, CA 92083
Phone (760) 941-9002

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: iibrahim11128@epiclp.direct-ci.com

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1811944598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E COOLEY DR",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923243905",
            "telephone_number": "909-370-4179",
            "fax_number": "909-796-4158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "IRENY",
        "middle_name": "I.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-28",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A64541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A645410",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colton, CA

Sources for this page

Verify at the official NPI Registry.