Individual provider Active NPI

Ayesha Ikram

  • Internal Medicine Physician
  • Montgomery, AL
National Provider Identifier
1922622380
Registry record updated Jul 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125077130 Issued in IL
Practice address
Baptist South 2105 E South Blvd
Montgomery, AL 36116
Phone
(334) 288-2100
NPI assigned
Jun 2, 2020
Last updated
Jul 3, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125077130 IL Primary

Addresses

Primary practice location

Baptist South 2105 E South Blvd
Montgomery, AL 36116

Mailing address

2105 E Sooth Blvd
Montogomery, AL 36116
Phone (334) 288-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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

Enrollment IDStateProvider typePAC IDDetails
I20231229002529 AL Practitioner - Internal Medicine 8123478302 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

400 Taylor Rd
Montgomery, AL 36117-3512
Phone (334) 277-8330

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125077130ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center Current Accepting new patients
Hospital Physician Services - Southeast Professional Corporation CurrentSince Oct 15, 2023 Accepting new patients
Health Care Authority for Baptist Health, an Affiliate of Uabhs Past Accepting new patients

Locations

2105 E South Blvd
Montgomery, AL 36116
Phone (334) 286-2842

400 Taylor Rd
Montgomery, AL 36117
Phone (334) 213-6287

124 S Memorial Dr
Prattville, AL 36067
Phone (334) 361-4267

1643 NW 136th Ave
Ste 100
Sunrise, FL 33323
Phone (865) 500-1325

Interoperability endpoints

  • Direct secure messaging: aikram126042@direct.luhs.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1591056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688342400000",
    "number": "1922622380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 E SOOTH BLVD",
            "city": "MONTOGOMERY",
            "state": "AL",
            "postal_code": "36116",
            "telephone_number": "334-288-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BAPTIST SOUTH 2105 E SOUTH BLVD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "36116",
            "telephone_number": "334-288-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IKRAM",
        "first_name": "AYESHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-02",
        "last_updated": "2023-07-03",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125077130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

Verify at the official NPI Registry.