NPIMap

Individual provider Active NPI

Mirna Georges Boumitri, M.D.

  • Nephrology Physician
  • Minneapolis, MN
National Provider Identifier
1053580092
Registry record updated Apr 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
52751 Issued in MN
Practice address
516 Delaware St SE
Clinic 2a
Minneapolis, MN 55455
Phone
(612) 626-1687
NPI assigned
Feb 25, 2008
Last updated
Apr 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 57.010274 OH
Internal Medicine Physician 207R00000X 52751 MN
Nephrology Physician 207RN0300X 52751 MN Primary

Addresses

Primary practice location

516 Delaware St SE
Clinic 2a
Minneapolis, MN 55455

Mailing address

717 Delaware St SE
Mail Code 1932
Minneapolis, MN 55414-2959
Phone (612) 624-6843

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
I20101026000304 MN Practitioner - NephrologyPractitioner - Internal Medicine 5799978409 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Drexel University College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

1045 Westgate Dr
Suite 90
Saint Paul, MN 55114-1079
Phone (651) 645-1847

14500 99TH Ave N
Suite 100
Maple Grove, MN 55369-4738
Phone (763) 898-1000

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (855) 324-7843

303 E Nicollet Blvd
Suite 160
Burnsville, MN 55337-4588
Phone (952) 460-4000

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 672-7422

606 24TH Ave S
Minneapolis, MN 55454-1437

6341 University Ave NE
Fridley, MN 55432-4946
Phone (763) 572-5700

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

6525 France Ave S
Suite 200
Edina, MN 55435-2176
Phone (952) 848-8890

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

720 Washington Ave SE
Minneapolis, MN 55414-2924
Phone (612) 884-0649

909 Fulton St SE
Minneapolis, MN 55455-4800
Phone (612) 672-7422

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57.010274OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Jan 1, 2019 Accepting new patients
Fairview Health Services Current Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Jan 1, 2019 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Bethesda Hospital CurrentSince Mar 24, 2020 Accepting new patients
Fairview Express Care CurrentSince Sep 1, 2014 Accepting new patients
University of Minnesota Physicians Current Accepting new patients
Healtheast Care System CurrentSince Mar 24, 2020 Accepting new patients
Fairview Health Services CurrentSince Sep 1, 2014 Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
University of Minnesota Physicians CurrentSince Nov 6, 2010 Accepting new patients

Locations

420 Delaware St SE
#126
Minneapolis, MN 55455
Phone (612) 626-2378

516 Delaware St SE
#2A
Minneapolis, MN 55455
Phone (612) 626-1687

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0331

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

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

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

559 Capitol Blvd
Saint Paul, MN 55103
Phone (651) 232-2000

Interoperability endpoints

  • Direct secure messaging: mboumitri149207@fairview.direct-ci.com

Organizations & group practices 12

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": "1203897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680825600000",
    "number": "1053580092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 DELAWARE ST SE",
            "address_2": "MAIL CODE 1932",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554142959",
            "telephone_number": "612-624-6843",
            "fax_number": "612-626-3840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 DELAWARE ST SE",
            "address_2": "CLINIC 2A",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55455",
            "telephone_number": "612-626-1687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUMITRI",
        "first_name": "MIRNA",
        "middle_name": "GEORGES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-25",
        "last_updated": "2023-04-07",
        "certification_date": "2023-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "57.010274",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "52751",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MN",
            "license": "52751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.