Individual provider Active NPI

Ilyas A Abdikadir, LPCC

  • Home Health Aide
  • Roseville, MN
National Provider Identifier
1063729747
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AideTaxonomy code 374U00000X
License
2740 Issued in MN
Practice address
1751 County Road B W Ste 101
Roseville, MN 55113-4037
Phone
(612) 615-6848
Fax
(763) 201-7979
NPI assigned
Sep 1, 2010
Last updated
Apr 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 2740 MN
Group Psychotherapy Psychologist 103TP2701X 2740 MN
Home Health Aide 374U00000X 2740 MN Primary

Addresses

Primary practice location

1751 County Road B W Ste 101
Roseville, MN 55113-4037

Mailing address

1751 County Road B W Ste 101
Roseville, MN 55113-4037
Phone (612) 615-6848

Other practice location 1

5005 Texas St
203
San Diego, CA 92108-3721
Phone (619) 692-0727

Other identifiers 2

IdentifierTypeStateIssuer
922503090OtherMNPSYCHOTHERAPY
843569697OtherMNHOME HEALTH CARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2740MNMDGroup Psychotherapy Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Onefamily Therapy & Wellness Center LLC CurrentSince Apr 1, 2022 Accepting new patients

Locations

3617 E Lake St
Ste J
Minneapolis, MN 55406

1751 County Road B W
Ste 101
Roseville, MN 55113
Phone (612) 236-4686

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1283299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1063729747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1751 COUNTY ROAD B W STE 101",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551134037",
            "telephone_number": "612-615-6848",
            "fax_number": "763-201-7979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 COUNTY ROAD B W STE 101",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551134037",
            "telephone_number": "612-615-6848",
            "fax_number": "763-201-7979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5005 Texas St",
            "address_2": "203",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921083721",
            "country_code": "US",
            "telephone_number": "619-692-0727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ABDIKADIR",
        "first_name": "ILYAS",
        "middle_name": "A",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-01",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "2740",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "MN",
            "license": "2740",
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "MN",
            "license": "2740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOTHERAPY",
            "identifier": "922503090",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME HEALTH CARE",
            "identifier": "843569697",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.