Omer Ibrahim

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036143080 Issued in IL

Practice address

515 N State St Ste 900
Chicago, IL 60654

Phone

(312) 245-9965

Fax

(312) 245-9964

NPI assigned

Mar 28, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Dermatology

Education

Yale University School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Rush University Medical Group

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1093819542

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Rush University Medical Center

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1689165540

  Dermatology

  NPD
• Derick Dermatology, PLLC

  • Dermatology Physician
  • Arlington Heights, IL
  • NPI 1497792618

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1332892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1871869438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 N STATE ST STE 900",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606549104",
            "telephone_number": "312-245-9965",
            "fax_number": "312-245-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 N STATE ST STE 900",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60654",
            "telephone_number": "312-245-9965",
            "fax_number": "312-245-9964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9500 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441950001",
            "country_code": "US",
            "telephone_number": "216-444-2200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 N State St Ste 900",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60654",
            "country_code": "US",
            "telephone_number": "312-245-9965",
            "fax_number": "312-245-9964",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "OMER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-28",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "IL",
            "license": "036.143080",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036143080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Israh Ibrahim
• Khalil Ibrahim, M.D.
• Manal Ibrahim, DMD
• Mohamed Attia Ibrahim, PT, DSC, MS, NCS
• Nadine Anne Ibrahim, LCSW
• Sarah Ibrahim, MD
• Sideeq Ademola Ibrahim, MPH
• Sonia Ibrahim, PHARMD
• Yasmine Ibrahim, MD
• Zeina Samir Ibrahim, M.D.

• Dermatology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; 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.

Verify at the official NPI Registry.