NPIMap

Individual provider Active NPI

Nabeel Bishara Ailabouni, DO

  • Family Medicine Physician
  • Big Lake, MN
National Provider Identifier
1043479876
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
105377 Issued in 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
Last updated
Nov 4, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 105377 MN Primary

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 1

TypeEndpointUseAffiliation
Direct Messaging Address nailabouni186988@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110919000714 MN Practitioner - Family Practice 6305032467 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
St Cloud, MN 56303-2735
Phone (320) 252-5131

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
105377MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
St. Cloud Hospital Current Accepting new patients
Centracare Health System-NR LLC CurrentSince Dec 30, 2017 Accepting new patients
Centracare Clinic CurrentSince Aug 3, 2020 Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
Centracare Clinic CurrentSince Aug 3, 2020 Accepting new patients
St. Cloud Hospital CurrentSince May 1, 2020 Accepting new patients
St. Cloud Hospital CurrentSince May 1, 2020 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

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1555 Northway Dr
#H
Saint Cloud, MN 56303
Phone (320) 240-3157

1555 Northway Dr
Ste 200
Saint Cloud, MN 56303
Phone (320) 240-3157

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: nailabouni186988@excellian.direct.allina.com
  • Direct secure messaging: nailabouni26806@direct.centracare.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1043479876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16830 198TH AVE NW",
            "address_2": "BIG LAKE CLINIC",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "55309",
            "telephone_number": "763-263-7300",
            "fax_number": "763-263-7334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16830 198TH AVE NW",
            "address_2": "BIG LAKE CLINIC",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "55309",
            "telephone_number": "763-263-7300",
            "fax_number": "763-263-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AILABOUNI",
        "first_name": "NABEEL",
        "middle_name": "BISHARA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-06",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "105377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nailabouni186988@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "9055 Springbrook Dr NW",
            "city": "Coon Rapids",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554335841",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Big Lake, MN

Sources for this page

Verify at the official NPI Registry.