NPIMap

Individual provider Active NPI

Mohamed Abdi Adan

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1336725837
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1801 Nicollet Ave
Minneapolis, MN 55403-3791
Phone
(612) 823-2947
Fax
(612) 870-2947
NPI assigned
Mar 23, 2021
Last updated
Jun 23, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1801 Nicollet Ave
Minneapolis, MN 55403-3791

Mailing address

2300 E Franklin Ave
Minneapolis, MN 55406-1072
Phone (857) 492-6395

Other practice location 1

1 W Lake St
Minneapolis, MN 55408-3154
Phone (612) 823-2947

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20230509000904 MN Practitioner - Physician Assistant 0547646531 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Commonwealth Medical College, 2021
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Primemed PLLCGroup PAC ID 6709241185, 2 clinicians

Practice addresses (Care Compare)

322 W Lake St
Suite 101
Minneapolis, MN 55408-3025
Phone (857) 492-6395

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13901MNMDPhysical Therapist

Interoperability endpoints

  • Direct secure messaging: mohamed.adan.1@29159.direct.athenahealth.com

Organizations & group practices 1

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 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1336725837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 E FRANKLIN AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554061072",
            "telephone_number": "857-492-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 NICOLLET AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554033791",
            "telephone_number": "612-823-2947",
            "fax_number": "612-870-2947"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 W Lake St",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554083154",
            "country_code": "US",
            "telephone_number": "612-823-2947",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADAN",
        "first_name": "MOHAMED",
        "middle_name": "ABDI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-23",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.