Individual provider Active NPI

Ahmad Abou Yassine, M.D

  • Gastroenterology Physician
  • Albuquerque,, NM
National Provider Identifier
1720645310
Registry record updated Jun 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD2015-0851 Issued in NM
Practice address
Gastroenterology
1100 Lead Ave SE
Albuquerque,, NM 87106-5215
Phone
(505) 224-7000
Fax
(505) 224-7292
NPI assigned
May 20, 2019
Reactivated
Feb 19, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD2015-0851 NM Primary

Addresses

Primary practice location

Gastroenterology
1100 Lead Ave SE
Albuquerque,, NM 87106-5215

Mailing address

PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 224-7000

Other practice location 1

475 Seaview Avenue
Staten Island, NY 10305
Phone (718) 226-8855

Other practice location 2

Msc10 5550 1 University Of New Mexico
Albuquerque, NM 87131-0001
Phone (505) 272-4661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1125 Upland Dr NE
Albuquerque, NM 87112-5845

PO Box
Albuquerque, NM 87125

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RS2023-1071NMMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782604800000",
    "number": "1720645310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PHS PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-224-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GASTROENTEROLOGY",
            "address_2": "1100 LEAD AVE SE",
            "city": "ALBUQUERQUE,",
            "state": "NM",
            "postal_code": "871065215",
            "telephone_number": "505-224-7000",
            "fax_number": "505-224-7292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Seaview Avenue",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "10305",
            "country_code": "US",
            "telephone_number": "718-226-8855",
            "fax_number": "718-226-1347",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Msc10 5550 1 University Of New Mexico",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871310001",
            "country_code": "US",
            "telephone_number": "505-272-4661",
            "fax_number": "505-272-0475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ABOU YASSINE",
        "first_name": "AHMAD",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-20",
        "last_updated": "2026-06-28",
        "certification_date": "2026-06-28",
        "deactivation_date": "2020-01-17",
        "reactivation_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NM",
            "license": "MD2015-0851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque,, NM

Sources for this page

Verify at the official NPI Registry.