Active NPI
Fadumo Ahmed Ali
- Pediatric Nurse Practitioner
- St Paul, MN
National Provider Identifier
1598389199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 9664
- Practice address
- 963 S. Robert St. West
St Paul, MN 55118-1446 - Phone
- (507) 319-1198
- NPI assigned
- May 31, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2460612 | MN | |
| Pediatric Nurse Practitioner | 363LP0200X | 9664 | MN | Primary |
Addresses
Primary practice location
963 S. Robert St. West
St Paul, MN 55118-1446
Mailing address
963 S. Robert St. West
St Paul, MN 55118-1446
Phone (507) 319-1195
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2460612 | MN | MD | Registered Nurse |
| 9664 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metropolitan Pediatric Specialists, P.a. | Single Specialty | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
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": "1590883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666915200000",
"number": "1598389199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "963 S. ROBERT ST. WEST",
"city": "ST PAUL",
"state": "MN",
"postal_code": "551181446",
"telephone_number": "507-319-1195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "963 S. ROBERT ST. WEST",
"city": "ST PAUL",
"state": "MN",
"postal_code": "551181446",
"telephone_number": "507-319-1198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALI",
"first_name": "FADUMO",
"middle_name": "AHMED",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-31",
"last_updated": "2022-10-28",
"certification_date": "2022-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Registered Nurse",
"state": "MN",
"license": "2460612",
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MN",
"license": "9664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.