Rose Ibrahim

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9119022 Issued in FL

Practice address

125 W Copeland Dr
Orlando, FL 32806-2101

Phone

(321) 841-7090

Fax

(321) 843-2267

NPI assigned

Sep 19, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MA, FL2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Orlando Health Hospital, Orlando, FL, CCN 100006

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

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.

• Orlando Health Medical Group Inc

  • Internal Medicine Physician
  • Orlando, FL
  • NPI 1669429577
  Medicare reassignment Care Compare group NPD
• Brigham & Womens Physicians Organization Inc

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1033535497
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Orlando Health, Inc.

  • General Acute Care Hospital
  • Orlando, FL
  • NPI 1184709057
  Care Compare affiliation

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

{
    "created_epoch": "1632009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1902576150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 W COPELAND DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32806",
            "telephone_number": "321-841-7090",
            "fax_number": "321-843-2267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 W COPELAND DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062101",
            "telephone_number": "321-841-7090",
            "fax_number": "321-843-2267"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "360 Huntington Avenue",
            "address_2": "202 Robinson Hall/PA program",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02115",
            "country_code": "US",
            "telephone_number": "617-373-3195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-19",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA9089",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9119022",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124041500",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ibrahim.ro@northeastern.edu",
            "affiliation": "N",
            "address_1": "360 Huntington Avenue",
            "address_2": "202 Robinson Hall/PA program",
            "city": "Boston",
            "state": "MA",
            "country_code": "US",
            "postal_code": "02115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ahmed Ramadan Ibrahim, DMD
• Joseph Abdellatif Ibrahim, MD
• Kerollos George Ibrahim, MD
• Mena Ibrahim, DDS
• Mustafa Ramadan Ibrahim, DO
• Denisse Icaza, CERTIFIED DOULA
• Ichcare Inc.
• Icon Pharmaceuticals Inc
• Icon Pharmacy
• Isaac Idani

• Surgical Physician Assistant in Orlando, FL
• Providers in Orlando, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.