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Individual provider Active NPI

Momodou Ceesay, GNP

  • Gerontology Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1649438417
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
2508 Issued in MN
Practice address
3433 Broadway St NE Ste 300
Minneapolis, MN 55413-1761
Phone
(763) 587-7737
Fax
(763) 587-7069
NPI assigned
May 29, 2008
Last updated
May 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 2508 MN Primary

Addresses

Primary practice location

3433 Broadway St NE Ste 300
Minneapolis, MN 55413-1761

Mailing address

3433 Broadway St NE Ste 300
Minneapolis, MN 55413-1761
Phone (763) 587-7737

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
I20081010000172 MN Practitioner - Nurse Practitioner 0648348102 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geriatric Services of Minnesota LLCGroup PAC ID 2365667557, 44 clinicians
Genevive Aco LLCGroup PAC ID 8628585080, 43 clinicians

Practice addresses (Care Compare)

3433 Broadway St NE
Suite 300
Minneapolis, MN 55413-1761
Phone (763) 587-7737

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2508MNMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Genevive Aco LLC CurrentSince Sep 1, 2025 Accepting new patients
Geriatric Services of Minnesota, LLC CurrentSince Jun 2, 2014 Accepting new patients

Locations

200 Park Ln
Buffalo, MN 55313
Phone (763) 682-1131

715 1st St N
Cold Spring, MN 56320
Phone (320) 685-3693

515 Division St
Excelsior, MN 55331
Phone (952) 474-5488

725 2nd Ave S
Hopkins, MN 55343
Phone (910) 535-1211

3433 Broadway St NE
Ste 300
Minneapolis, MN 55413
Phone (763) 857-7737

618 E 17th St
Minneapolis, MN 55404
Phone (612) 332-3541

5430 Boone Ave N
New Hope, MN 55428
Phone (763) 492-3000

3401 E Medicine Lake Blvd
Plymouth, MN 55441
Phone (763) 231-5924

7727 Portland Ave
Richfield, MN 55423
Phone (612) 455-0304

Organizations & group practices 2

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1649438417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3433 BROADWAY ST NE STE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131761",
            "telephone_number": "763-587-7737",
            "fax_number": "763-587-7069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3433 BROADWAY ST NE STE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131761",
            "telephone_number": "763-587-7737",
            "fax_number": "763-587-7069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CEESAY",
        "first_name": "MOMODOU",
        "credential": "GNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-29",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "2508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.