Individual provider Active NPI

Khadra Muse, FNP

  • Family Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1013470715
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024177192 Issued in VA
Practice address
3809 42ND Ave S Ste 100
Minneapolis, MN 55406-3503
Phone
(612) 405-3554
NPI assigned
Apr 9, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024177192 VA Primary

Addresses

Primary practice location

3809 42ND Ave S Ste 100
Minneapolis, MN 55406-3503

Mailing address

3809 42ND Ave S Ste 100
Minneapolis, MN 55406-3503
Phone (612) 405-3554

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20220214001999 MN Practitioner - Nurse Practitioner 1557754652 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bluecrescent Urgent Care LLCGroup PAC ID 6608231659, 2 clinicians

Practice addresses (Care Compare)

3809 42ND Ave S
Suite 100
Minneapolis, MN 55406-1234
Phone (612) 405-3554

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
8554MNMDSpeech-Language Pathologist
0024177192VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bluecrescent Urgent Care LLC CurrentSince Mar 1, 2023 Accepting new patients
Pathway Recuperative Care Current Accepting new patients

Locations

3809 42nd Ave S
Ste 100
Minneapolis, MN 55406
Phone (612) 405-3554

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IIAGAA/Endpoint/IIAGAA
  • FHIR API: https://fhir4.healow.com/fhir/r4/EFEADD/Endpoint/EFEADD

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.

NPI Registry JSON

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1013470715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3809 42ND AVE S STE 100",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554063503",
            "telephone_number": "612-405-3554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3809 42ND AVE S STE 100",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554063503",
            "telephone_number": "612-405-3554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSE",
        "first_name": "KHADRA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-09",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024177192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.