Individual provider Active NPI

Bashir Moallin, MBBS

  • Family Medicine Physician
  • Saint Cloud, MN
National Provider Identifier
1144840463
Registry record updated Dec 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
70813 Issued in MN
Practice address
1555 Northway Dr Ste 200
Saint Cloud, MN 56303-4913
Phone
(320) 240-3157
Fax
(320) 240-3164
NPI assigned
Apr 17, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 70813 MN Primary

Addresses

Primary practice location

1555 Northway Dr Ste 200
Saint Cloud, MN 56303-4913

Mailing address

3405 3Rd St N
Saint Cloud, MN 56303-4015
Phone (320) 774-1041

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220510002368 MN Practitioner - Family Practice 6608299821 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hayat Clinic PLLCGroup PAC ID 4183063175, 4 clinicians

Practice addresses (Care Compare)

3405 3Rd St N
Saint Cloud, MN 56303-4015
Phone (320) 774-1041

Hospital & facility affiliations

  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
70813MNMDFamily Medicine Physician
30966MNMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hayat Clinic PLLC CurrentSince Apr 11, 2024 Accepting new patients

Locations

3405 3rd St N
Saint Cloud, MN 56303
Phone (320) 253-0567

Interoperability endpoints

  • Direct secure messaging: bashir.moallin.1@31517.direct.athenahealth.com

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.

Hospital & facility affiliations 6

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": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735344000000",
    "number": "1144840463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3405 3RD ST N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034015",
            "telephone_number": "320-774-1041",
            "fax_number": "320-774-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 NORTHWAY DR STE 200",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034913",
            "telephone_number": "320-240-3157",
            "fax_number": "320-240-3164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOALLIN",
        "first_name": "BASHIR",
        "name_prefix": "Dr.",
        "credential": "MBBS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-17",
        "last_updated": "2024-12-28",
        "certification_date": "2024-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "70813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.