Idil Abdirahman Mohamed, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11720 Issued in MN

Practice address

8170 Old Carriage CT Ste 100
Shakopee, MN 55379-3164

Phone

(952) 428-3600

Fax

(952) 428-3636

NPI assigned

Dec 4, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of North Dakota School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairview Health ServicesGroup PAC ID 1951213057, 677 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• M Health Fairview Ridges Hospital Hospital, Burnsville, MN, CCN 240207

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Carextra Home Health, LLC

  • Home Health Agency
  • Edina, MN
  • NPI 1992343925

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership

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.

• Fairview Health Services

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1811077175
  Medicare reassignment Care Compare group
• Healtheast Medical Research Institute

  • Clinic/Center
  • Vadnais Heights, MN
  • NPI 1639125503
  Medicare reassignment NPD
• St. Francis Regional Medical Center

  • Urgent Care Clinic/Center
  • Shakopee, MN
  • NPI 1447605514
  Medicare reassignment NPD
• Carextra Home Health, LLC

  • Home Health Agency
  • Edina, MN
  • NPI 1992343925
  NPD Authorized official
• Fairview Health Services

  • Hospitalist Physician
  • Princeton, MN
  • NPI 1013097377
  NPD
• Fairview Health Services

  • Land Ambulance
  • Saint Paul, MN
  • NPI 1710212485
  NPD
• Healtheast Medical Research Insititue

  • Clinic/Center
  • Woodbury, MN
  • NPI 1598356560
  NPD
• Healtheast Medical Research Institute

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1508191552
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Fairview Health Services

  • General Acute Care Hospital
  • Burnsville, MN
  • NPI 1225199128
  Care Compare affiliation
• Fairview Health Services

  • General Acute Care Hospital
  • Burnsville, MN
  • NPI 1245217520
  Care Compare affiliation

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

{
    "created_epoch": "1417651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1255738373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8170 OLD CARRIAGE CT STE 100",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553793164",
            "telephone_number": "952-428-3600",
            "fax_number": "952-428-3636"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 Drew Ave SE",
            "address_purpose": "LOCATION",
            "city": "Madelia",
            "state": "MN",
            "postal_code": "560621841",
            "country_code": "US",
            "telephone_number": "507-642-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOHAMED",
        "first_name": "IDIL",
        "middle_name": "ABDIRAHMAN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-04",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "11720",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "11720",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mission Chiropractic & Acupuncture PLLC
• Kasie Jean Mix, O.D., M.S.
• Asma Mohamed I
• Fardowsa Ali Mohamed
• Fardowsa Darar Mohamed
• Nimo Mohamud Mohamed
• Anisa Sophia Mohammed, PSYD, LP
• Catherine M Mohn, CRNA
• Alyssa Molnar
• Steven Norman Monroe, OD

• Physician Assistant in Shakopee, MN
• Providers in Shakopee, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.