Mazen M Ibrahim

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01028371A Issued in IN

Practice address

9423 Highway 403
Charlestown, IN 47111-9664

Phone

(812) 256-6388

Fax

(812) 256-0475

NPI assigned

Mar 15, 2006

Sex

Male

Sole proprietor

No

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.

• Daviess County Hospital

  • Skilled Nursing Facility
  • New Albany, IN
  • NPI 1841625662
  NPD (past)
• Floyd Memorial Hospital and Health Services

  • Internal Medicine Physician
  • Charlestown, IN
  • NPI 1457516643

  Family Medicine

  NPD (past)
• Floyd Memorial Medical Group LLC

  • Family Medicine Physician
  • New Albany, IN
  • NPI 1790925782

  Family Medicine

  NPD (past)
• Community Medical Associates, Inc.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1588614994

  Family Medicine

  NPD (past)
• Norton Enterprises, Inc.

  • Urgent Care Clinic/Center
  • Louisville, KY
  • NPI 1104863562
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 20, 2011.

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295481600000",
    "number": "1952370710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9423 HIGHWAY 403",
            "city": "CHARLESTOWN",
            "state": "IN",
            "postal_code": "471119664",
            "telephone_number": "812-256-6388",
            "fax_number": "812-256-0475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9423 HIGHWAY 403",
            "city": "CHARLESTOWN",
            "state": "IN",
            "postal_code": "471119664",
            "telephone_number": "812-256-6388",
            "fax_number": "812-256-0475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MAZEN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2011-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01028371A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100075220",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000042374",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Audrey Hochgesang
• Rita Lynn Hoffman, RN, BSN, RNFA
• Hoke Medical
• William Enloe Hoke Jr., M.D.
• Kacie J Howell, LPN
• Indiana Emergency Physicians LLP
• Crystal Isaacs, PHARM.D., R.PH.
• Jimmy Floyd Sharp
• Janna Marie Johnson, FNP-C
• Leslie Johnson, ATC

• All providers in Charlestown, IN
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.