Active NPI
Ismaila Musa Jibrin, M.D.
- Internal Medicine Physician
- Cottonwood, AZ
National Provider Identifier
1962522680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 37838
- Practice address
- 269 S Candy LN
Cottonwood, AZ 86326-4158 - Phone
- (928) 639-5588
- Fax
- (928) 639-5589
- NPI assigned
- Mar 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | PENDING | CT | |
| Internal Medicine Physician | 207R00000X | 37838 | AZ | Primary |
Addresses
Primary practice location
269 S Candy LN
Cottonwood, AZ 86326-4158
Mailing address
1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 213-6235
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 349871 | Medicaid | AZ |
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
| License | State | Type | Specialty |
|---|---|---|---|
| PENDING | CT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Verde Valley Medical Center | Past | Accepting new patients | |
| Griffin Faculty Physicians, Inc. | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- Cottonwood, AZ
- NPI 1346291648
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Derby, CT
- NPI 1598755605
Internal Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618876800000",
"number": "1962522680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 N BEAVER ST",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860013118",
"telephone_number": "928-213-6235",
"fax_number": "928-213-6292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "269 S CANDY LN",
"city": "COTTONWOOD",
"state": "AZ",
"postal_code": "863264158",
"telephone_number": "928-639-5588",
"fax_number": "928-639-5589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIBRIN",
"first_name": "ISMAILA",
"middle_name": "MUSA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-29",
"last_updated": "2021-04-20",
"certification_date": "2021-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CT",
"license": "PENDING",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AZ",
"license": "37838",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "349871",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Cottonwood, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.