Individual provider Active NPI

Mazen M Ibrahim

  • Family Medicine Physician
  • Charlestown, IN
National Provider Identifier
1952370710
Registry record updated Jan 20, 2011
On this page

Key facts

NPPES NPI Registry
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
Last updated
Jan 20, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01028371A IN Primary

Addresses

Primary practice location

9423 Highway 403
Charlestown, IN 47111-9664

Mailing address

9423 Highway 403
Charlestown, IN 47111-9664
Phone (812) 256-6388

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01028371AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Enterprises, Inc. Past Accepting new patients
Floyd Memorial Hospital and Health Services Family Medicine Past Accepting new patients
Community Medical Associates, Inc. Family Medicine Past Accepting new patients
Floyd Memorial Medical Group LLC Family Medicine Past Accepting new patients
Daviess County Hospital Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlestown, IN

Sources for this page

  • 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.