Individual provider Active NPI

Abiye Lawrence Ibiebele, MD

  • Sports Medicine (Emergency Medicine) Physician
  • Ypsilanti, MI
National Provider Identifier
1922530252
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X
License
4301507290 Issued in MI
Practice address
5301 McAuley Dr
Ypsilanti, MI 48197-1051
Phone
(734) 712-3000
NPI assigned
Mar 27, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 287482 MA
Emergency Medicine Physician 207P00000X 125069944 IL
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 287482 MA
Sports Medicine (Emergency Medicine) Physician 207PS0010X 4301507290 MI Primary

Addresses

Primary practice location

5301 McAuley Dr
Ypsilanti, MI 48197-1051

Mailing address

5301 McAuley Dr
Ypsilanti, MI 48197-1051
Phone (734) 712-3456

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220117000512 MA Practitioner - Orthopedic SurgeryPractitioner - Emergency Medicine 3476827833 Reassigns benefits to 4 organizations
I20220708001617 MI Practitioner - Emergency Medicine 3476827833 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Washington University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Massachusetts General Physicians Organization IncGroup PAC ID 2466365820, 3,494 clinicians

Practice addresses (Care Compare)

1575 Cambridge St
Cambridge, MA 02138-4308
Phone (617) 876-4344

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

Hospital & facility affiliations

  • Massachusetts General Hospital Hospital, Boston, MA, CCN 220071

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301507290MIMDSports Medicine (Emergency Medicine) Physician
287482MAMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Epmg of Michigan, P.C. Emergency Medicine CurrentSince Jun 17, 2022 Accepting new patients
The General Hospital Corporation CurrentSince Oct 1, 2023 Accepting new patients
Massachusetts General Physicians Organization Inc Emergency Medicine CurrentSince Oct 1, 2023 Accepting new patients
General Hospital Corp Current Accepting new patients
Steward Emergency Physicians, Inc Emergency Medicine CurrentSince Jan 16, 2022 Accepting new patients

Locations

200 Groton Rd
Ayer, MA 01432
Phone (978) 784-9000

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

55 Fruit St
Boston, MA 02114

736 Cambridge St
Brighton, MA 02135
Phone (617) 789-2762

88 Washington St
Taunton, MA 02780
Phone (508) 828-7000

775 S Main St
Chelsea, MI 48118
Phone (313) 995-3764

620 Byron Rd
Howell, MI 48843
Phone (517) 545-5450

5301 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-7246

Interoperability endpoints

  • Direct secure messaging: ibiebele.abiye.mgh@direct.partners.masshiway.net
  • Direct secure messaging: aibiebele1984471@direct.trinity-health.org

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1922530252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 MCAULEY DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971051",
            "telephone_number": "734-712-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 MCAULEY DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971051",
            "telephone_number": "734-712-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBIEBELE",
        "first_name": "ABIYE",
        "middle_name": "LAWRENCE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-27",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "287482",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125069944",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "MA",
            "license": "287482",
            "primary": false
        },
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "MI",
            "license": "4301507290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.