Individual provider Active NPI

Disa L.G. Awah, DO

  • Internal Medicine Physician
  • Minot, ND
National Provider Identifier
1174838650
Registry record updated Feb 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
13345 Issued in ND
Practice address
400 Burdick Expy E
Minot, ND 58701-4768
Phone
(701) 857-7969
Fax
(701) 857-7957
NPI assigned
Aug 9, 2010
Last updated
Feb 25, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 13345 ND Primary

Addresses

Primary practice location

400 Burdick Expy E
Minot, ND 58701-4768

Mailing address

PO Box 5010
Minot, ND 58702-5010
Phone (701) 857-5650

Other identifiers 1

IdentifierTypeStateIssuer
81339MedicaidND

Other names 1

  • Disa L Grant Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20180905003793 IA Practitioner - Internal Medicine 3678710464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1001 N Ctr Point Rd
Suite C
Hiawatha, IA 52233-1237
Phone (319) 362-0200

1075 N Ctr Point Rd
Pediatrics Hiawatha
Hiawatha, IA 52233-1231
Phone (319) 743-1440

4480 Utica Ridge Rd
Bettendorf, IA 52722-1644

4480 Utica Ridge Rd
Suite 160
Bettendorf, IA 52722-1637
Phone (563) 742-5950

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Iowa Physicians Clinic Medical Foundation Internal Medicine CurrentSince Aug 6, 2018 Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

1001 N Center Point Rd
Ste C
Hiawatha, IA 52233
Phone (319) 362-0200

8101 Birchwood Ct
Unit R
Urbandale, IA 50131
Phone (515) 471-9363

Interoperability endpoints

  • Direct secure messaging: dawah614256@direct.unitypoint.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1281312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424822400000",
    "number": "1174838650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5010",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587025010",
            "telephone_number": "701-857-5650",
            "fax_number": "701-854-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 BURDICK EXPY E",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587014768",
            "telephone_number": "701-857-7969",
            "fax_number": "701-857-7957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AWAH",
        "first_name": "DISA",
        "middle_name": "L.G.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-09",
        "last_updated": "2015-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ND",
            "license": "13345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81339",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DISA",
            "last_name": "GRANT",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Minot, ND

Sources for this page

Verify at the official NPI Registry.