Individual provider Active NPI

Shahrior Imrul Kayes, ANP-BC, C.N.P.

  • Adult Health Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1659638690
Registry record updated Oct 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
R 183010 -1 Issued in MN
Practice address
5101 Minnehaha Ave
Minneapolis, MN 55417-1647
Phone
(612) 548-5830
NPI assigned
Apr 16, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X R 183010 -1 MN Primary

Addresses

Primary practice location

5101 Minnehaha Ave
Minneapolis, MN 55417-1647

Mailing address

5101 Minnehaha Ave
Minneapolis, MN 55417-1647
Phone (612) 548-5830

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120828000575 MN Practitioner - Nurse Practitioner 6103073077 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of Minnesota-Minnesota Management and BudgetGroup PAC ID 1658268677, 4 clinicians

Practice addresses (Care Compare)

5101 Minnehaha Ave
Minneapolis, MN 55417-1647
Phone (612) 548-5709

Hospital & facility affiliations

  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R 183010 -1MNMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
State of Minnesota-Minnesota Management and Budget CurrentSince Mar 28, 2018 Accepting new patients
State of Minnesota-Minnesota Management and Budget CurrentSince Mar 28, 2018 Accepting new patients

Locations

5101 Minnehaha Ave
Minneapolis, MN 55417
Phone (612) 548-5709

5101 Minnehaha Ave
Bldg 10
Minneapolis, MN 55417

56 Outer Dr
Silver Bay, MN 55614
Phone (218) 226-6300

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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": "1334534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1659638690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 MINNEHAHA AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171647",
            "telephone_number": "612-548-5830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 MINNEHAHA AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171647",
            "telephone_number": "612-548-5830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAYES",
        "first_name": "SHAHRIOR",
        "middle_name": "IMRUL",
        "credential": "ANP-BC, C.N.P.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-16",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "R 183010 -1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.