Active NPI
Ibrahim Amae Elemo, M.D.
- Internal Medicine Physician
- Decatur, IL
National Provider Identifier
1831478627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036134398
- Practice address
- 1800 E Lake Shore Dr
Decatur, IL 62521-3810 - Phone
- (217) 464-5811
- Fax
- (217) 464-1318
- NPI assigned
- Aug 10, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | 036134398 | IL | |
| Hospitalist Physician | 208M00000X | 61530 | MN | |
| Internal Medicine Physician | 207R00000X | 036134398 | IL | Primary |
Addresses
Primary practice location
1800 E Lake Shore Dr
Decatur, IL 62521-3810
Mailing address
1800 E Lake Shore Dr
Decatur, IL 62521-3810
Phone (217) 464-5811
Other practice location 1
1025 Marsh St
Mankato, MN 56001-4752
Phone (507) 385-4863
Other practice location 2
4500 Memorial Dr
Belleville, IL 62226-5360
Phone (618) 257-6220
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ielemo1326357@ehrdirect.mayoclinicmsg.org | ||
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA, MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1575 Beam Ave
Maplewood, MN 55109-1126
Phone (651) 232-7000
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 273-3000
3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 520-5200
Hospital & facility affiliations
- M Health Fairview University of MN Medical Center
- Maple Grove Hospital
- North Memorial Health Hospital
- M Health Fairview St John'S Hospital
- Fairview University Trans Serv
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mayo Clinic Health System-Southwest Minnesota Region | Current | Accepting new patients | |
| Healtheast Woodwinds Hospital | Current | Accepting new patients | |
| Healtheast Medical Research Institute | Internal Medicine | Current | Accepting new patients |
| North Memorial Health Care | Current | Accepting new patients | |
| Fairview Express Care | Current | Accepting new patients | |
| Fairview Express Care | Current | Accepting new patients | |
| Mayo Clinic Health System-Southwest Minnesota Region | Current | Accepting new patients | |
| Fairview Health Services | Current | Accepting new patients | |
| Healtheast St. John'S Hospital | Current | Accepting new patients | |
| North Memorial Health Care | Hospitalist | Current | Accepting new patients |
| Healtheast Medical Research Institute | Current | Accepting new patients | |
| North Memorial Health Care | Current | Accepting new patients | |
| Fairview Health Services | Current | Accepting new patients | |
| Healtheast Medical Research Institute | Current | Accepting new patients | |
| Fairview Express Care | Current | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients | |
| Fairview Health Services | Past | Accepting new patients | |
| Fairview Health Services | Past | Accepting new patients |
Locations
14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400
1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623
2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838
717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617
911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313
3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048
1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273
45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000
1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000
69 Exchange St W
Saint Paul, MN 55102
Phone (651) 232-1100
1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100
Organizations & group practices 19
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.
-
- Multi-Specialty Clinic/Center
- Mankato, MN
- NPI 1578545422
MN
-
- Specialist
- Edina, MN
- NPI 1467116186
-
- General Practice Physician
- Edina, MN
- NPI 1831707207
-
- General Acute Care Hospital
- Minneapolis, MN
- NPI 1013994359
-
- Land Ambulance
- Saint Paul, MN
- NPI 1710212485
-
- Internal Medicine Physician
- Saint Paul, MN
- NPI 1508191552
Internal Medicine
Hospital & facility affiliations 9
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Maple Grove, MN
- NPI 1225272552
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615507200000",
"number": "1831478627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 E LAKE SHORE DR",
"city": "DECATUR",
"state": "IL",
"postal_code": "625213810",
"telephone_number": "217-464-5811",
"fax_number": "217-464-1318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 E LAKE SHORE DR",
"city": "DECATUR",
"state": "IL",
"postal_code": "625213810",
"telephone_number": "217-464-5811",
"fax_number": "217-464-1318"
}
],
"practiceLocations": [
{
"address_1": "1025 Marsh St",
"address_purpose": "LOCATION",
"city": "Mankato",
"state": "MN",
"postal_code": "560014752",
"country_code": "US",
"telephone_number": "507-385-4863",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4500 Memorial Dr",
"address_purpose": "LOCATION",
"city": "Belleville",
"state": "IL",
"postal_code": "622265360",
"country_code": "US",
"telephone_number": "618-257-6220",
"fax_number": "618-257-6679",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ELEMO",
"first_name": "IBRAHIM",
"middle_name": "AMAE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-10",
"last_updated": "2021-03-12",
"certification_date": "2021-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "IL",
"license": "036134398",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "MN",
"license": "61530",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036134398",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ielemo1326357@ehrdirect.mayoclinicmsg.org",
"affiliation": "N",
"address_1": "1025 Marsh St",
"city": "Mankato",
"state": "MN",
"country_code": "US",
"postal_code": "560014752",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"endpointDescription": "BJC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "4500 Memorial Dr",
"city": "Belleville",
"state": "IL",
"country_code": "US",
"postal_code": "622265360",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.