Adnan Abdill Hussein

Key facts

NPI

1124742457

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Analyst 103K00000X

Practice address

1066 County Highway 10 Unit 305
Spring Lake Park, MN 55432-2664

Phone

(612) 707-6426

NPI assigned

Sep 29, 2022

Sex

Male

Sole proprietor

No

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 and National Provider Directory roles.

• Oasis Autism Center, LLC Early Intervention Provider Agency · Minneapolis, MN · NPI 1003559261
  NPD

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 29, 2022.

{
    "created_epoch": "1664409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1124742457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4008 MINNEHAHA AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554063306",
            "telephone_number": "612-387-6968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1066 COUNTY HIGHWAY 10 UNIT 305",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554322664",
            "telephone_number": "612-707-6426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUSSEIN",
        "first_name": "ADNAN",
        "middle_name": "ABDILL",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-29",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CLINIC",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Spring Lake Park, MN · Behavior Analyst in Minnesota