Active NPI
Shamso Haji Jama
- Physician Assistant
- Minneapolis, MN
National Provider Identifier
1083220776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 14318
- Practice address
- 2211 Riverside Ave
Minneapolis, MN 55454-1350 - Phone
- (612) 330-1399
- NPI assigned
- Sep 18, 2020
- Last updated
- Mar 22, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 14318 | MN | Primary |
Addresses
Primary practice location
2211 Riverside Ave
Minneapolis, MN 55454-1350
Mailing address
808 Berry St Apt 470
Saint Paul, MN 55114-1380
Phone (507) 369-8983
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14318 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679443200000",
"number": "1083220776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "808 BERRY ST APT 470",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551141380",
"telephone_number": "507-369-8983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 RIVERSIDE AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541350",
"telephone_number": "612-330-1399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAMA",
"first_name": "SHAMSO",
"middle_name": "HAJI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-18",
"last_updated": "2023-03-22",
"certification_date": "2023-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "14318",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.