Individual provider Active NPI

Abdikhaliq Anwar Mohamed

  • Behavior Analyst
  • Minneapolis, MN
National Provider Identifier
1417653403
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
6260 Highway 65 NE Ste 303
Minneapolis, MN 55432-5150
Phone
(614) 218-3069
NPI assigned
Feb 1, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X Primary

Addresses

Primary practice location

6260 Highway 65 NE Ste 303
Minneapolis, MN 55432-5150

Mailing address

2811 15TH Ave S
Minneapolis, MN 55407-1425
Phone (651) 500-9096

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Empower Skill Academy LLC CurrentSince Feb 8, 2023 Accepting new patients

Locations

6260 Highway 65 NE
Ste 303
Minneapolis, MN 55432
Phone (612) 402-1673

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1675209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1417653403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 15TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071425",
            "telephone_number": "651-500-9096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6260 HIGHWAY 65 NE STE 303",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554325150",
            "telephone_number": "614-218-3069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAMED",
        "first_name": "ABDIKHALIQ",
        "middle_name": "ANWAR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-02-01",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.