IBRAHIM HEART CLINIC PLLC – Clinical Cardiac Electrophysiology Physician, NPI 1629511035
Clinical Cardiac Electrophysiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for IBRAHIM HEART CLINIC PLLC
319 W Call St Ste B
Starke, FL 320913172
Phone: (904) 580-4730
Fax: (904) 580-4740
Type: Location
1590 Island Ln Ste 73
Fleming Island, FL 320034409
Phone: (904) 580-4730
Fax: (904) 580-4740
Type: Location
213 S US Highway 17 Ste Ab
East Palatka, FL 321314005
Phone: (904) 580-4730
Type: Location
1921 Alice St Ste 4A
Waycross, GA 315016202
Phone: (904) 580-4730
Fax: (904) 580-4740
Type: Location
13842, Harbor Creek Place, Pablo Bay, Jacksonville, Duval County, Florida, 32224, United States
JACKSONVILLE, FL 322246895
Phone: (904) 962-6005
Type: Mailing
5150 BELFORT RD BLDG 400
JACKSONVILLE, FL 322566026
Phone: (904) 580-4730
Fax: (904) 580-4740
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-11-01
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-08-31 (281 days ago).
Enrollment records
2
Earliest due date
2025-08-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20170313000103 | O | Clinic/Group Practice | FL | TBD |
| O20191101002132 | O | Clinic/Group Practice | GA | 2025-08-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32091)
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