Active NPI
Yassir K Ibrahim
- Home Health Agency
- Faribault, MN
National Provider Identifier
1174265342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Practice address
- 800 Conliffe Ave SW Apt 203
Faribault, MN 55021-5792 - Phone
- (507) 491-2300
- NPI assigned
- Apr 8, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Primary |
Addresses
Primary practice location
800 Conliffe Ave SW Apt 203
Faribault, MN 55021-5792
Mailing address
800 Conliffe Ave SW Apt 203
Faribault, MN 55021-5792
Phone (507) 491-2300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C0063538 | Other | MN | HOME 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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649376000000",
"number": "1174265342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 CONLIFFE AVE SW APT 203",
"city": "FARIBAULT",
"state": "MN",
"postal_code": "550215792",
"telephone_number": "507-491-2300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 CONLIFFE AVE SW APT 203",
"city": "FARIBAULT",
"state": "MN",
"postal_code": "550215792",
"telephone_number": "507-491-2300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "YASSIR",
"middle_name": "K",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-08",
"last_updated": "2022-04-08",
"certification_date": "2022-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HOME CARE",
"identifier": "C0063538",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Faribault, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.