Individual provider Active NPI

Ahmad Malli, MD

  • Gastroenterology Physician
  • Minneapolis, MN
National Provider Identifier
1033464888
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
63187 Issued in MN
Practice address
701 Park Ave
Minneapolis, MN 55415-1623
Phone
(612) 873-3000
NPI assigned
Jul 18, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 24737 MN
Gastroenterology Physician 207RG0100X 63187 MN Primary

Addresses

Primary practice location

701 Park Ave
Minneapolis, MN 55415-1623

Mailing address

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-3000

Other practice location 1

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 254-3242

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180620000303 MN Practitioner - Gastroenterology 5496065823 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hennepin Healthcare System IncGroup PAC ID 4789684861, 905 clinicians

Practice addresses (Care Compare)

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-6963

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy33
Upper gastrointestinal (GI) endoscopy for acid reflux49

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63187MNMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Sep 4, 2024 Accepting new patients
Group Health, Inc. CurrentSince Sep 4, 2024 Accepting new patients
Hennepin Healthcare System, Inc Current Accepting new patients
Hennepin Healthcare System, Inc CurrentSince Jul 16, 2018 Accepting new patients
Hennepin Healthcare System Inc CurrentSince Jul 16, 2018 Accepting new patients
Hennepin Faculty Associates Past Accepting new patients

Locations

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

701 Park Ave
#350
Minneapolis, MN 55415
Phone (612) 873-5334

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

715 S 8th St
Minneapolis, MN 55404
Phone (612) 873-6010

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

Organizations & group practices 6

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1033464888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Jackson St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551012502",
            "country_code": "US",
            "telephone_number": "651-254-3242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLI",
        "first_name": "AHMAD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-18",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "24737",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MN",
            "license": "63187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.