Individual provider Active NPI

Marina Ibrahim

  • Physician Assistant
  • Chicago Heights, IL
National Provider Identifier
1992430524
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
152 W Lincoln Hwy
Chicago Heights, IL 60411-2619
Phone
(708) 754-9687
NPI assigned
Jul 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

152 W Lincoln Hwy
Chicago Heights, IL 60411-2619

Mailing address

600 W Fulton St
Chicago, IL 60661-1259
Phone (312) 526-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221222002154 IL Practitioner - Physician Assistant 7113397720 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Access Community Health NetworkGroup PAC ID 9537076112, 182 clinicians

Practice addresses (Care Compare)

152 W Lincoln Hwy
Chicago Heights, IL 60411-2619
Phone (708) 754-9687

15200 Lincoln Hwy
Heights, IL 60411-2619
Phone (708) 754-9687

7450 W 63Rd St
Des Plaines Valley Family Health Center
Summit, IL 60501-1816
Phone (708) 458-0757

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Access Community Health Network CurrentSince Dec 9, 2022 Accepting new patients
Access Community Health Network CurrentSince Dec 9, 2022 Accepting new patients
Access Community Health Network Past Accepting new patients

Locations

600 W Fulton St
Ste 200
Chicago, IL 60661
Phone (312) 526-2000

600 W Fulton St
Chicago, IL 60661
Phone (312) 526-2100

152 W Lincoln Hwy
Chicago Hts, IL 60411
Phone (708) 754-9687

Organizations & group practices 4

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 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": "1658102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1992430524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W FULTON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606611259",
            "telephone_number": "312-526-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 W LINCOLN HWY",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604112619",
            "telephone_number": "708-754-9687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MARINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-18",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago Heights, IL

Sources for this page

Verify at the official NPI Registry.