NPIMap

Individual provider Active NPI

Mirit Mohsen Yacoup, MD

  • Internal Medicine Physician
  • Saint Paul, MN
National Provider Identifier
1366007023
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
71222 Issued in MN
Practice address
640 Jackson St
Saint Paul, MN 55101-2502
Phone
(651) 254-3456
NPI assigned
May 7, 2019
Last updated
Sep 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 71222 MN Primary

Addresses

Primary practice location

640 Jackson St
Saint Paul, MN 55101-2502

Mailing address

8170 33Rd Ave S # Ms 21110Q
Bloomington, MN 55425-4516

Other practice location 1

420 Delaware St SE
Minneapolis, MN 55455-0341
Phone (612) 626-5454

Other practice location 2

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-5000

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
I20230921003782 MN Practitioner - Internal Medicine 7012244353 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wright State University Boonshoft School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 254-4786

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71222MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hutchinson Health CurrentSince Nov 28, 2023 Accepting new patients
Park Nicollet Clinic CurrentSince Sep 11, 2023 Accepting new patients
Park Nicollet Methodist Hospital CurrentSince Sep 11, 2023 Accepting new patients
Healthpartners RC CurrentSince Nov 28, 2023 Accepting new patients
Healthpartners RC CurrentSince Nov 28, 2023 Accepting new patients
Group Health, Inc. CurrentSince Sep 11, 2023 Accepting new patients
Park Nicollet Clinic Current Accepting new patients
Group Health, Inc. CurrentSince Sep 11, 2023 Accepting new patients
Regions Hospital Past Accepting new patients

Locations

1029 Highway 15 S
Hutchinson, MN 55350
Phone (320) 275-3358

420 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-6483

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

100 Healthy Way
Olivia, MN 56277
Phone (320) 523-1261

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246

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.

Hospital & facility affiliations 8

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": "1557187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1366007023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012502",
            "telephone_number": "651-254-3456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 Delaware St SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554550341",
            "country_code": "US",
            "telephone_number": "612-626-5454",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6500 Excelsior Blvd",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554264702",
            "country_code": "US",
            "telephone_number": "952-993-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YACOUP",
        "first_name": "MIRIT",
        "middle_name": "MOHSEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-07",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "71222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.