Active NPI
Mohamad Ibrahim Itani, MD
- Gastroenterology Physician
- Minneapolis, MN
National Provider Identifier
1023698131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 79942
- Practice address
- 420 Delaware St SE
Minneapolis, MN 55455-0341 - Phone
- (651) 491-4295
- NPI assigned
- Apr 12, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 79942 | MN | Primary |
| Internal Medicine Physician | 207R00000X | 79942 | MN |
Addresses
Primary practice location
420 Delaware St SE
Minneapolis, MN 55455-0341
Mailing address
420 Delaware St SE
Minneapolis, MN 55455-0341
Phone (651) 491-4295
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
4055 Valley View LN
Suite 700
Dallas, TX 75244-4910
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Signify Health Medical Associates, PLLC | Current | Accepting new patients |
Locations
1010 Dale St N
Saint Paul, MN 55117
Phone (612) 482-6610
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Organizations & group practices 1
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": "1618185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751673600000",
"number": "1023698131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550341",
"telephone_number": "651-491-4295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550341",
"telephone_number": "651-491-4295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ITANI",
"first_name": "MOHAMAD",
"middle_name": "IBRAHIM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-12",
"last_updated": "2025-07-05",
"certification_date": "2025-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MN",
"license": "79942",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MN",
"license": "79942",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.