Ideal Medclinic Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

IDEAL MEDCLINIC INC

Practice address

6572 River Park Dr Ste 102
Riverdale, GA 30274-2214

Phone

(770) 629-2296

NPI assigned

Nov 3, 2021

Organization subpart

No

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

Authorized official

Name

Melissa Salcido

Title

Cfo

Phone

(678) 314-7235

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eloy Edilberto Diaz Sr., M.D.

  • Internal Medicine Physician
  • Riverdale, GA
  • NPI 1063461051
  Medicare reassignment NPD

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635897600000",
    "number": "1841955937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6572 RIVER PARK DR STE 102",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742214",
            "telephone_number": "770-629-2296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6572 RIVER PARK DR STE 102",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742214",
            "telephone_number": "770-629-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL MEDCLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-03",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A",
        "authorized_official_last_name": "SALCIDO",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "678-314-7235"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shamira Hurst, BSW
• Hygeia Health
• Jada Hyland
• Essam Salah Eliwa Sanad Ibrahim, M.D
• Icare & Associates, LLC
• Ideal Therapy Rehabilitative Services II, LLC (Ideal Therapy II)
• Christianah O Idowu, CNA
• Agwu Mang Ifendu
• Infectious Disease Associates 2 LLC
• Infectious Diseases Associates, PC

• Family Medicine Physician in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.