Active NPI
Mahilet Sisay, CNP
- Gerontology Nurse Practitioner
- St Louis Park, MN
National Provider Identifier
1609205707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 10934
- Practice address
- 5320 W 23Rd St Ste 130
St Louis Park, MN 55416-1670 - Phone
- (952) 345-3213
- NPI assigned
- Nov 8, 2013
- 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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 10934 | MN | Primary |
| Addiction (Substance Use Disorder) Registered Nurse | 163WA0400X | R 203829-0 | MN |
Addresses
Primary practice location
5320 W 23Rd St Ste 130
St Louis Park, MN 55416-1670
Mailing address
1375 Davern St Apt 408
Saint Paul, MN 55116-2290
Phone (651) 925-9735
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5123 W 98TH St
Suite 2082
Minneapolis, MN 55437-2040
Phone (737) 226-6700
5320 W 23Rd St
Suite 130
St Louis Park, MN 55416-1670
Phone (952) 345-3213
Hospital & facility affiliations
- Lifespark Home Health
- Lakeview Hospice
- M Health Fairview University of MN Medical Center
- Abbott Northwestern Hospital
- M Health Fairview Southdale Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 203829-0 | MN | MD | Addiction (Substance Use Disorder) Registered Nurse |
| 10934 | MN | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spark Medical Providers PA | Current | Accepting new patients | |
| Curana Health of Minnesota PLLC | Current | Accepting new patients | |
| CH Specialty Services MN PC | Current | Accepting new patients | |
| Lifespark Medical Group, PA | Gerontology | Current | Accepting new patients |
| Minnesota Quality Care, Inc. | Past | Accepting new patients |
Locations
5123 W 98th St
Minneapolis, MN 55437
Phone (312) 961-4490
5320 W 23rd St
Ste 130
St Louis Park, MN 55416
Phone (952) 345-3213
Interoperability endpoints
- mahilet.sisay.2@15699.direct.athenahealth.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- mahilet.sisay.1@17901.direct.athenahealth.com
Organizations & group practices 5
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.
-
- Internal Medicine Physician
- Minneapolis, MN
- NPI 1083365084
-
- Geriatric Medicine (Family Medicine) Physician
- St Louis Park, MN
- NPI 1427551746
Gerontology
-
- Internal Medicine Physician
- Minneapolis, MN
- NPI 1841999158
-
- Geriatric Medicine (Internal Medicine) Physician
- St Louis Park, MN
- NPI 1760374680
-
- Home Health Agency
- Minneapolis, MN
- NPI 1346444957
Hospital & facility affiliations 30
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707350400000",
"number": "1609205707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1375 DAVERN ST APT 408",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551162290",
"telephone_number": "651-925-9735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5320 W 23RD ST STE 130",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161670",
"telephone_number": "952-345-3213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SISAY",
"first_name": "MAHILET",
"credential": "CNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-11-08",
"last_updated": "2024-02-08",
"certification_date": "2024-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "MN",
"license": "10934",
"primary": true
},
{
"code": "163WA0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "R 203829-0",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.