NPIMap

Individual provider Active NPI

Abdallah M Mansour, MD

  • Cardiovascular Disease Physician
  • Fargo, ND
National Provider Identifier
1003337973
Registry record updated Jun 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
19014 Issued in ND
Practice address
3000 32ND Ave S
Fargo, ND 58103-6132
Phone
(701) 364-8900
NPI assigned
Jun 30, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2017015904 MO
Cardiovascular Disease Physician 207RC0000X 72507 MN
Cardiovascular Disease Physician 207RC0000X 19014 ND Primary

Addresses

Primary practice location

3000 32ND Ave S
Fargo, ND 58103-6132

Mailing address

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8900

Other practice location 1

1 Hospital Dr # Dc043.00
Columbia, MO 65212-1000
Phone (573) 884-1606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230705002492 ND Practitioner - Cardiovascular Disease (Cardiology) 0941570477 Reassigns benefits to 1 organization
I20230707001024 MN Practitioner - Cardiovascular Disease (Cardiology) 0941570477 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Innovis Health LLC 561 clinicians

Practice addresses (Care Compare)

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

Hospital & facility affiliations

  • Essentia Health Hospital, Fargo, ND, CCN 350070
  • Essentia Health St Marys - Detroit Lakes Hospital, Detroit Lakes, MN, CCN 240101
  • Essentia Health St Joseph'S Medical Center Hospital, Brainerd, MN, CCN 240075
  • Essentia Health Fosston Hospital, Fosston, MN, CCN 241357
  • Linton Hospital - Cah Hospital, Linton, ND, CCN 351328

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017015904MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health, LLC Current Accepting new patients
St. Marys Regional Health Center Current Accepting new patients
St Mary'S Regional Health Center CurrentSince Jul 24, 2023 Accepting new patients
Innovis Health LLC CurrentSince Jul 24, 2023 Accepting new patients
Innovis Health, LLC CurrentSince Jul 24, 2023 Accepting new patients
St Mary'S Regional Health Center CurrentSince Jul 24, 2023 Accepting new patients

Locations

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222

Organizations & group practices 12

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 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1498780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1003337973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 32ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036132",
            "telephone_number": "701-364-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 32ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036132",
            "telephone_number": "701-364-8900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Hospital Dr # Dc043.00",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652121000",
            "country_code": "US",
            "telephone_number": "573-884-1606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "ABDALLAH",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-30",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2017015904",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MN",
            "license": "72507",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "ND",
            "license": "19014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.