NPIMap

Individual provider Active NPI

Mohamed Coulibaly Dit Fall

  • Family Nurse Practitioner
  • Tucson, AZ
National Provider Identifier
1255745840
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
TAP5641 Issued in AZ
Practice address
6600 N Oracle Rd Ste 100
Tucson, AZ 85704-5676
Phone
(520) 575-9007
Fax
(520) 575-0041
NPI assigned
Jun 11, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X TAP5641 AZ Primary

Addresses

Primary practice location

6600 N Oracle Rd Ste 100
Tucson, AZ 85704-5676

Mailing address

6600 N Oracle Rd Ste 100
Tucson, AZ 85704-5676
Phone (520) 575-9007

Other practice location 1

4781 W Santa Maria Dr
Amado, AZ 85645-9744
Phone (520) 256-7028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150203002277 AZ Practitioner - Nurse Practitioner 1456676949 Reassigns benefits to 3 organizations
Practice locations: Tucson, AZ

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11069 N Mountain Breeze Dr
Tucson, AZ 85737-7066
Phone (520) 256-7028

6600 N Oracle Rd
Suite 100
Tucson, AZ 85704-5676
Phone (520) 575-9007

Hospital & facility affiliations

  • Northwest Medical Center Hospital, Tucson, AZ, CCN 030085

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TAP5641AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ama Family Practice PLLC CurrentSince Apr 15, 2023 Accepting new patients
Sonora Behavioral Health Hospital, LLC CurrentSince Oct 7, 2017 Accepting new patients
Sonora Behavioral Health Hospital, LLC CurrentSince Oct 7, 2017 Accepting new patients
Buena Vista Recovery PastSince May 1, 2020 Accepting new patients
Buena Vista Recovery, LLC PastSince Nov 8, 2020 Accepting new patients
Buena Vista Recovery, LLC PastSince Jul 16, 2023 Accepting new patients
Buena Vista Recovery, LLC Past Accepting new patients
Buena Vista Recovery, LLC PastSince May 31, 2020 Accepting new patients
Buena Vista Recovery, LLC Past Accepting new patients
Buena Vista Recovery, LLC PastSince Jul 16, 2023 Accepting new patients
Mirasol, Inc. Past Accepting new patients

Locations

6050 N Corona Rd
Tucson, AZ 85704
Phone (520) 469-8700

6600 N Oracle Rd
Ste 100
Tucson, AZ 85704
Phone (520) 575-9007

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24675/brand/1/csg/1/fhir/r4
  • Direct secure messaging: mohamed.coulibaly.dit.fall.1@24675.direct.athenahealth.com

Organizations & group practices 12

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.

Hospital & facility affiliations 1

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": "1402444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1255745840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 N ORACLE RD STE 100",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857045676",
            "telephone_number": "520-575-9007",
            "fax_number": "520-575-0041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 N ORACLE RD STE 100",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857045676",
            "telephone_number": "520-575-9007",
            "fax_number": "520-575-0041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4781 W Santa Maria Dr",
            "address_purpose": "LOCATION",
            "city": "Amado",
            "state": "AZ",
            "postal_code": "856459744",
            "country_code": "US",
            "telephone_number": "520-256-7028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COULIBALY DIT FALL",
        "first_name": "MOHAMED",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-11",
        "last_updated": "2021-02-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "TAP5641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.