Individual provider Active NPI

Folorunso Ibraheem, DNP, MBBS, CFNP

  • Family Nurse Practitioner
  • Hyattsville, MD
National Provider Identifier
1861636979
Registry record updated Dec 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP 9193808 Issued in FL
Practice address
7760 Landover Rd
Hyattsville, MD 20785-2135
Phone
(305) 776-9911
Fax
(301) 798-9901
NPI assigned
Apr 21, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP 9193808 FL Primary

Addresses

Primary practice location

7760 Landover Rd
Hyattsville, MD 20785-2135

Mailing address

2312 Parkside Dr
Bowie, MD 20721-4223
Phone (302) 985-2099

Other practice location 1

2312 Parkside Dr
Bowie, MD 20721-4223
Phone (305) 776-9911

Other practice location 2

100 S Main St
Greensboro, MD 21639-1634
Phone (410) 482-4434

Other identifiers 1

IdentifierTypeStateIssuer
I165-240-52-387-0OtherFLDRIVER LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20190520000544 TX Practitioner - Nurse Practitioner 3870788250 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ARNP 9193808FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Winslow Indian Health Care Center, Inc CurrentSince Apr 8, 2019 Accepting new patients
Grassroots Health Care Inc Current Accepting new patients
Health on Wheel Corporation CurrentSince Apr 21, 2024 Accepting new patients
Dilkon Medical Center Current Accepting new patients
Winslow Indian Health Care Center, Inc CurrentSince Apr 8, 2019 Accepting new patients
Winslow Indian Health Care Center, Inc Current Accepting new patients

Locations

500 Indiana Ave
Winslow, AZ 86047

7760 Landover Rd
Landover, MD 20785
Phone (301) 825-4059

Organizations & group practices 6

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": "1240272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1861636979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2312 PARKSIDE DR",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207214223",
            "telephone_number": "302-985-2099",
            "fax_number": "949-862-8021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7760 LANDOVER RD",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207852135",
            "telephone_number": "305-776-9911",
            "fax_number": "301-798-9901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2312 Parkside Dr",
            "address_purpose": "LOCATION",
            "city": "Bowie",
            "state": "MD",
            "postal_code": "207214223",
            "country_code": "US",
            "telephone_number": "305-776-9911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 S Main St",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "MD",
            "postal_code": "216391634",
            "country_code": "US",
            "telephone_number": "410-482-4434",
            "fax_number": "949-862-8021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBRAHEEM",
        "first_name": "FOLORUNSO",
        "credential": "DNP, MBBS, CFNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-21",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP 9193808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER LICENSE",
            "identifier": "I165-240-52-387-0",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hyattsville, MD

Sources for this page

Verify at the official NPI Registry.