Advanced Care Clinic LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

ADVANCED CARE CLINIC LLC

Practice address

1317 E Lake St Ste 4
Minneapolis, MN 55407-6601

Phone

(612) 285-3417

Fax

(612) 254-8247

NPI assigned

Dec 12, 2023

Organization subpart

No

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

Authorized official

Name

Ifrah A Abdullahi, MSN, FNP, APRNNPI 1649804519

Title

Owner

Phone

(612) 285-3417

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ifrah Abdi Abdullahi, CNP

  • Family Nurse Practitioner
  • Minneapolis, MN
  • NPI 1649804519
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1702339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702944000000",
    "number": "1174391940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 E LAKE ST STE 4",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554076601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 E LAKE ST STE 4",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554076601",
            "telephone_number": "612-285-3417",
            "fax_number": "612-254-8247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED CARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-12",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A",
        "authorized_official_last_name": "ABDULLAHI",
        "authorized_official_first_name": "IFRAH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-285-3417",
        "authorized_official_credential": "MSN, FNP, APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.