Active NPI
Ahmad Abou Yassine, M.D
- Gastroenterology Physician
- Albuquerque,, NM
National Provider Identifier
1720645310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- MD2015-0851
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
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
| License | State | Type | Specialty |
|---|---|---|---|
| RS2023-1071 | NM | MD | Student 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.