Individual provider Active NPI

Mounir Ayoub

  • Home Health Registered Nurse
  • Blaine, MN
National Provider Identifier
1689207169
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health Registered NurseTaxonomy code 163WH0200X
License
R199206-5 Issued in MN
Practice address
10255 Madison St NE
Blaine, MN 55434-4229
Phone
(651) 367-9906
NPI assigned
Feb 12, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Registered Nurse 163WH0200X R199206-5 MN Primary

Addresses

Primary practice location

10255 Madison St NE
Blaine, MN 55434-4229

Mailing address

10255 Madison St NE
Blaine, MN 55434-4229
Phone (651) 367-9906

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

State licenses

LicenseStateTypeSpecialty
R199206-5MNMDHome Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Adequate Home Care LLC CurrentSince May 31, 2020 Accepting new patients

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": "1581465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1689207169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10255 MADISON ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344229",
            "telephone_number": "651-367-9906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10255 MADISON ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344229",
            "telephone_number": "651-367-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYOUB",
        "first_name": "MOUNIR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-12",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "MN",
            "license": "R199206-5",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; 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.