Nabeel Bishara Ailabouni, DO
Individual provider Active NPI Family Medicine Physician · Big Lake, MN
NPI 1043479876 · NPPES record last updated Nov 4, 2020
Key facts
- NPI
- 1043479876
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 105377 (MN)
- Practice address
- 16830 198TH Ave NW
Big Lake Clinic
Big Lake, MN 55309 - Phone
- (763) 263-7300
- Fax
- (763) 263-7334
- NPI assigned
- Jun 6, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 22
Hospital & facility affiliations 10
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Centracare Clinic
Practice addresses (Care Compare)
1200 6TH Ave N
St Cloud, MN 56303-2735
Phone (320) 252-5131
Hospital & facility affiliations
- Centracare Home Health
- Centracare Hospice
- Centracare Health - Monticello
- Centracare - St. Cloud Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110919000714 | MN | Practitioner - Family Practice | 6305032467 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105377 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centracare Health System-NR LLC | Current |
Accepting new patients | |
| St. Cloud Hospital | Current |
Accepting new patients | |
| Centracare Clinic | Current | Accepting new patients | |
| Centracare Clinic | Current |
Accepting new patients | |
| St. Cloud Hospital | Current | Accepting new patients | |
| Centracare Health System-NR LLC | Current | Accepting new patients | |
| Centracare Clinic | Current |
Accepting new patients | |
| St. Cloud Hospital | Current |
Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients | |
| Genesis Medical Education Foundation Inc | Family Medicine | Past | Accepting new patients |
Locations
12800 Rolling Ridge Rd
Becker, MN 55308
Phone (763) 261-7000
16830 198th Ave NW
Big Lake, MN 55309
Phone (763) 263-7300
1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303
1555 Northway Dr
#H
Saint Cloud, MN 56303
Phone (320) 240-3157
1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422
1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342
1555 Northway Dr
Ste 200
Saint Cloud, MN 56303
Phone (320) 240-3157
Interoperability endpoints
- nailabouni186988@excellian.direct.allina.com
- nailabouni26806@direct.centracare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 105377 | MN | Yes |
Addresses
Primary practice location
16830 198TH Ave NW
Big Lake Clinic
Big Lake, MN 55309
Mailing address
16830 198TH Ave NW
Big Lake Clinic
Big Lake, MN 55309
Phone (763) 263-7300
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | nailabouni186988@excellian.direct.allina.com | Direct |
Other providers in Big Lake, MN
- Ronda M. Adelmann
- Kamal Ahmed
- Trent Leigh Anderson
- Apple Ride LLC
- Beautiful You Dermatology LLC
- Neeharika Bhashyam
- Big Lake Dental, PA
All providers in Big Lake, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.