Individual provider Active NPI

Ibrahim Abdiqani Mohamed

  • Behavior Technician
  • Brooklyn Center, MN
National Provider Identifier
1639060643
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
6160 Summit Dr N Ste 200
Brooklyn Center, MN 55430-2181
Phone
(619) 576-6887
Fax
(612) 234-4600
NPI assigned
Jul 9, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Primary

Addresses

Primary practice location

6160 Summit Dr N Ste 200
Brooklyn Center, MN 55430-2181

Mailing address

6160 Summit Dr N Ste 200
Brooklyn Center, MN 55430-2181
Phone (619) 576-6887

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
Impact Autism SC Current Accepting new patients

Locations

6160 Summit Dr N
Ste 200
Brooklyn Center, MN 55430
Phone (612) 440-7456

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": "1752019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752019200000",
    "number": "1639060643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6160 SUMMIT DR N STE 200",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302181",
            "telephone_number": "619-576-6887",
            "fax_number": "612-234-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6160 SUMMIT DR N STE 200",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302181",
            "telephone_number": "619-576-6887",
            "fax_number": "612-234-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAMED",
        "first_name": "IBRAHIM",
        "middle_name": "ABDIQANI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-09",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Center, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; 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.