NPIMap

Individual provider Active NPI

Kenan Tayssir Raddawi, MD

  • Hospitalist Physician
  • Baltimore, MD
National Provider Identifier
1699235333
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
71699 Issued in MN
Practice address
201 E University Pkwy
Dept of Medicine
Baltimore, MD 21218-2829
Phone
(410) 554-2284
Fax
(410) 554-2184
NPI assigned
Mar 20, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 71699 MN
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X 71699 MN Primary

Addresses

Primary practice location

201 E University Pkwy
Dept of Medicine
Baltimore, MD 21218-2829

Mailing address

1925 Woodwinds Dr Dept of
Woodbury, MN 55125-4445

Other names 1

  • Kenan Alraddawi Former name

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
I20220929002556 MN Practitioner - Internal Medicine 5496131385 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1700 University Ave W
Saint Paul, MN 55104-3727

1925 Woodwinds Dr
Woodbury, MN 55125-4445
Phone (651) 232-0100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.68 of 100Reported as group
Quality
89.73
Promoting interoperability
100
Improvement activities
40
Cost
80.99

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healtheast Medical Research Institute Internal Medicine CurrentSince Aug 16, 2022 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Health Services Internal Medicine CurrentSince Aug 16, 2022 Accepting new patients
Fairview Health Services Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Aug 16, 2022 Accepting new patients
Fairview Health Services CurrentSince Aug 16, 2022 Accepting new patients
Healtheast Woodwinds Hospital Past Accepting new patients

Locations

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

1700 University Ave W
Fl 1
Saint Paul, MN 55104
Phone (651) 232-2002

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Organizations & group practices 8

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 2

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": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1699235333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 WOODWINDS DR DEPT OF",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E UNIVERSITY PKWY",
            "address_2": "DEPT OF MEDICINE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212182829",
            "telephone_number": "410-554-2284",
            "fax_number": "410-554-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADDAWI",
        "first_name": "KENAN",
        "middle_name": "TAYSSIR",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-20",
        "last_updated": "2022-10-18",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "71699",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MN",
            "license": "71699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENAN",
            "last_name": "ALRADDAWI",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.