Individual provider Active NPI

Ebtihal Ahmed Mohamed Ahmed, MBBS

  • Pediatrics Physician
  • Mankato, MN
National Provider Identifier
1235653452
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
75936 Issued in MN
Practice address
1025 Marsh St
Mankato, MN 56001-4752
Phone
(507) 625-4031
NPI assigned
Jul 29, 2017
Last updated
Jul 7, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 4301516547 MI
Pediatrics Physician 208000000X 103129 WI
Pediatrics Physician 208000000X 75936 MN Primary
Pediatrics Physician 208000000X 2020-00654 NC

Addresses

Primary practice location

1025 Marsh St
Mankato, MN 56001-4752

Mailing address

1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-4717

Other practice location 1

700 West Ave S
La Crosse, WI 54601-8806
Phone (608) 785-0940

Other practice location 2

1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-4717

Other practice location 3

566 Ruin Creek Rd
Henderson, NC 27536-5932
Phone (252) 438-4143

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, MN, WI3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20200512003658 NC Practitioner - Pediatric Medicine 0648601393 Reassigns benefits to 1 organization
I20240122001886 MN Practitioner - Pediatric Medicine 0648601393 Reassigns benefits to 1 organization
I20251028004201 WI Practitioner - Pediatric Medicine 0648601393 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

PO Box
Minneapolis, MN 55486

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
75936MNMDPediatrics Physician
2020-00654NCMDPediatrics Physician
103129WIMDPediatrics Physician
4301516547MIMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Maria Parham Physician Practices, LLC Current Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Jan 8, 2024 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Jan 8, 2024 Accepting new patients
DLP Maria Parham Physician Practices LLC CurrentSince Jul 1, 2020 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. Current Accepting new patients
DLP Maria Parham Physician Practices, LLC CurrentSince Jul 1, 2020 Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Sep 16, 2025 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Past Accepting new patients

Locations

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

120 Charles Rollins Rd
Ste 105
Henderson, NC 27536
Phone (252) 438-2773

511 Ruin Creek Rd
Ste 101
Henderson, NC 27536
Phone (252) 436-0440

566 Ruin Creek Rd
Henderson, NC 27536
Phone (252) 436-1148

700 West Ave S
La Crosse, WI 54601
Phone (608) 791-4156

800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1501286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1235653452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095000",
            "telephone_number": "734-936-4717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752",
            "telephone_number": "507-625-4031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 West Ave S",
            "address_purpose": "LOCATION",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546018806",
            "country_code": "US",
            "telephone_number": "608-785-0940",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 E Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481095000",
            "country_code": "US",
            "telephone_number": "734-936-4717",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "566 Ruin Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NC",
            "postal_code": "275365932",
            "country_code": "US",
            "telephone_number": "252-438-4143",
            "fax_number": "303-343-4756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AHMED",
        "first_name": "EBTIHAL",
        "middle_name": "AHMED MOHAMED",
        "credential": "MBBS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-29",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "MI",
            "license": "4301516547",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "103129",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "75936",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2020-00654",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.