Individual provider Active NPI

Olivia Mabberi, APNP

  • Nurse Practitioner
  • Blaine, MN
National Provider Identifier
1013613660
Registry record updated Sep 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9918 Issued in MN
Practice address
4365 Pheasant Ridge Dr NE Ste 106
Blaine, MN 55449-4544
Phone
(888) 938-3838
Fax
(888) 919-1083
NPI assigned
Feb 6, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9918 MN Primary

Addresses

Primary practice location

4365 Pheasant Ridge Dr NE Ste 106
Blaine, MN 55449-4544

Mailing address

10001 W Innovation Dr Ste 200
Milwaukee, WI 53226-4851
Phone (888) 938-3838

Other names 1

  • Olivia Nabulwala Former name

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
I20230317002573 MN Practitioner - Nurse Practitioner 5698149425 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ear Institutes LLCGroup PAC ID 4880928761, 12 clinicians

Practice addresses (Care Compare)

9325 Upland LN N
Suite 200
Maple Grove, MN 55369-4443
Phone (888) 938-3838

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9918MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ear Institutes, LLC CurrentSince Sep 5, 2023 Accepting new patients
Sama Healthcare CurrentSince Mar 1, 2023 Accepting new patients

Locations

845 Vikings Pkwy
Ste B
Eagan, MN 55121
Phone (651) 650-0500

6640 Shady Oak Rd
Ste 255
Eden Prairie, MN 55344

9325 Upland Ln N
Ste 200
Maple Grove, MN 55369

2639 Nicollet Ave
Ste 130
Minneapolis, MN 55408
Phone (612) 886-2686

4365 Pheasant Ridge Dr NE
Ste 106
Minneapolis, MN 55449
Phone (763) 296-3277

8401 Seasons Pkwy
Ste 300
Woodbury, MN 55125

10001 W Innovation Dr
Ste 200
Wauwatosa, WI 53226

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19405/brand/1/csg/1/fhir/r4
  • Direct secure messaging: olivia.mabberi.1@19405.direct.athenahealth.com

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": "1675641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1013613660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 W INNOVATION DR STE 200",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264851",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4365 PHEASANT RIDGE DR NE STE 106",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494544",
            "telephone_number": "888-938-3838",
            "fax_number": "888-919-1083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MABBERI",
        "first_name": "OLIVIA",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-06",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "9918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OLIVIA",
            "last_name": "NABULWALA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Blaine, MN

Sources for this page

Verify at the official NPI Registry.