Idriss Ibrahim, CNP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

6251 Issued in MN

Practice address

309 E College Dr
Marshall, MN 56258-2379

Phone

(507) 530-6028

NPI assigned

Aug 10, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Mecca Medical Center, LLC

  • Family Medicine Physician
  • Marshall, MN
  • NPI 1336790864
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586995200000",
    "number": "1336525666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 BIRCH ST APT 2",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562581550",
            "telephone_number": "507-530-6028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 E COLLEGE DR",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562582379",
            "telephone_number": "507-530-6028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "IDRISS",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-08-10",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "6251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Louise Hubbard, RN, CDCES
• Angela L Hughes, PHARMD
• Leah Marie Humbert, APRN, PMHNP-BC
• Taylor Martin Huseby, DPT
• Hy-Vee Inc
• Inspiring Life Therapy
• International Quality Homecare Corporation
• Intrepid Mental Health LLC
• Jenna Renae Jackson, MS, LAT, ATC
• Nikki Lea Jacobson, APRN, CNM

• Family Medicine Physician in Marshall, MN
• Providers in Marshall, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.