Individual provider Active NPI

Irfan Mohammad Altafullah, M.B., B.S.

  • Neurology Physician
  • Golden Valley, MN
National Provider Identifier
1437103629
Registry record updated May 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
31625 Issued in MN
Practice address
4225 Golden Valley Rd
Golden Valley, MN 55422-4215
Phone
(763) 588-0661
Fax
(763) 287-2310
NPI assigned
May 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 31625 MN Primary

Addresses

Primary practice location

4225 Golden Valley Rd
Golden Valley, MN 55422-4215

Mailing address

4225 Golden Valley Rd
Golden Valley, MN 55422-4215
Phone (763) 588-0661

Other identifiers 9

IdentifierTypeStateIssuer
1437103629MedicaidMN
100277C029OtherMNUCARE
0265046OtherMNPREFERRED ONE
0522654OtherMNMEDICA
1D717ALOtherMNBCBS OF MN
31739300MedicaidWI
130006223OtherMNRAILROAD MEDICARE
HP12787OtherMNHEALTHPARTNERS
22781OtherMNAMERICA'S PPO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ialtafullah911@direct.northmemorial.com Direct

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100326000079 MN Practitioner - Neurology 5890876239 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minneapolis Clinic of Neurology LTDGroup PAC ID 5496668659, 75 clinicians

Practice addresses (Care Compare)

4225 Golden Valley Rd
Golden Valley, MN 55422-4215
Phone (763) 588-0661

Merit-based Incentive Payment System (MIPS)

Final score
92.39 of 100Reported as group
Quality
84.12
Promoting interoperability
100
Improvement activities
40
Cost
83.94

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31625MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Minneapolis Clinic of Neurology, LTD Neurology CurrentSince Sep 1, 1991 Accepting new patients

Locations

9645 Grove Cir N
Ste 100
Maple Grove, MN 55369
Phone (763) 302-4114

4225 Golden Valley Rd
Minneapolis, MN 55422
Phone (612) 588-0661

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

Interoperability endpoints

  • Direct secure messaging: ialtafullah911@direct.northmemorial.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1437103629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 GOLDEN VALLEY RD",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224215",
            "telephone_number": "763-588-0661",
            "fax_number": "763-287-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 GOLDEN VALLEY RD",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224215",
            "telephone_number": "763-588-0661",
            "fax_number": "763-287-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALTAFULLAH",
        "first_name": "IRFAN",
        "middle_name": "MOHAMMAD",
        "name_prefix": "Dr.",
        "credential": "M.B., B.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "31625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437103629",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "100277C029",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "0265046",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0522654",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "1D717AL",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31739300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "130006223",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP12787",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO",
            "identifier": "22781",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ialtafullah911@direct.northmemorial.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "4225 Golden Valley Rd",
            "city": "Golden Valley",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554224215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Golden Valley, MN

Sources for this page

Verify at the official NPI Registry.