Active NPI
Yasin Jama
- Contractor
- Bloomington, MN
National Provider Identifier
1780033076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- W963240252118
- Practice address
- 9810 Drew Avenue South
Apartment 106
Bloomington, MN 55431 - Phone
- (612) 703-4514
- NPI assigned
- Jun 7, 2016
- Last updated
- Jun 7, 2016
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | W963240252118 | MN | Primary |
Addresses
Primary practice location
9810 Drew Avenue South
Apartment 106
Bloomington, MN 55431
Mailing address
9810 Drew Ave S
Apt 106
Bloomington, MN 55431-2771
Phone (612) 703-4514
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
| License | State | Type | Specialty |
|---|---|---|---|
| W963240252118 | MN | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465257600000",
"number": "1780033076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9810 DREW AVE S",
"address_2": "APT 106",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554312771",
"telephone_number": "612-703-4514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9810 DREW AVENUE SOUTH",
"address_2": "APARTMENT 106",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "55431",
"telephone_number": "612-703-4514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAMA",
"first_name": "YASIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-07",
"last_updated": "2016-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "MN",
"license": "W963240252118",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.