NPIMap

Individual provider Active NPI

Ibrahim A Mujir, M.D.

  • Family Medicine Physician
  • Brooklyn Park, MN
National Provider Identifier
1649367210
Registry record updated Jul 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39507 Issued in MN
Practice address
8559 Edinbrook Pkwy
Ste 100
Brooklyn Park, MN 55443-3747
Phone
(763) 425-1888
NPI assigned
Oct 6, 2006
Last updated
Jul 9, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39507 MN Primary

Addresses

Primary practice location

8559 Edinbrook Pkwy
Ste 100
Brooklyn Park, MN 55443-3747

Mailing address

5320 W 23Rd St Ste 130
St Louis Park, MN 55416-1670
Phone (952) 345-3310

Other identifiers 1

IdentifierTypeStateIssuer
73815800MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080507000334 MN Practitioner - Family Practice 5395824940 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Lights Health LLCGroup PAC ID 6305278797, 11 clinicians

Practice addresses (Care Compare)

212 W Lake St
Waconia, MN 55387-1014
Phone (651) 603-4565

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.69 of 100Reported as group
Quality
91.97
Improvement activities
40
Cost
69.67

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39507MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Lights Health LLC CurrentSince Jun 5, 2023 Accepting new patients
Waterside Healthcare & Wellness, LLC CurrentSince Jun 5, 2023 Accepting new patients
Renville Olivia Holdings LLC Past Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients
Lifespark Home Health LLC Past Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients
Lifespark Home Health LLC Past Accepting new patients
North Cities Health Care, Inc. Past Accepting new patients
Faulkner and Reynolds Enterprises, Inc Past Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients
Senior Care Providence, LLC Past Accepting new patients
Guardian Angels Health Services, Inc. Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Good Samaritan Society - AmbassadorNew Hope, MN, CCN 245149 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2023
Feb 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1649367210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5320 W 23RD ST STE 130",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161670",
            "telephone_number": "952-345-3310",
            "fax_number": "952-345-8771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8559 EDINBROOK PKWY",
            "address_2": "STE 100",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554433747",
            "telephone_number": "763-425-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUJIR",
        "first_name": "IBRAHIM",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "39507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "73815800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Park, MN

Sources for this page

Verify at the official NPI Registry.