Adam Donald Ailabouni, M.D.
Individual provider Active NPI Family Medicine Physician · Saint Paul, MN
NPI 1780628461 · NPPES record last updated Mar 10, 2021
Key facts
- NPI
- 1780628461
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 47598 (MN)
- Practice address
- Ufp - Phalen Village Clinic
1414 Maryland Avenue East
Saint Paul, MN 55106 - Phone
- (651) 772-3461
- Fax
- (651) 772-2605
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Minnesota Medical School, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northfield Hospital
Practice addresses (Care Compare)
2000 N a Ve
Northfieldm, MN 55057-1498
2000 N Ave
Northfield, MN 55057-1498
Phone (507) 646-1478
2014 Jefferson Rd
Suite C
Northfield, MN 55057-3251
Phone (507) 646-6700
4645 Knutsen Dr
Farmington, MN 55024-8455
Phone (651) 460-2300
9974 214TH St W
Lakeville, MN 55044-1913
Phone (952) 469-0500
Hospital & facility affiliations
- Adara Home Health Inc
- Allina Health Home Health
- Northfield Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051011000787 | MN | Practitioner - Family Practice | 6204851025 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47598 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northfield Hospital | Current | Accepting new patients | |
| Northfield Hospital | Current |
Accepting new patients |
Locations
4645 Knutsen Dr
Farmington, MN 55024
Phone (651) 460-2300
9974 214th St W
Lakeville, MN 55044
Phone (952) 469-0500
2000 North Ave
Northfield, MN 55057
Phone (507) 646-1000
2014 Jefferson Rd
Ste Cd
Northfield, MN 55057
Phone (507) 646-6700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 47598 | MN | Yes |
Addresses
Primary practice location
Ufp - Phalen Village Clinic
1414 Maryland Avenue East
Saint Paul, MN 55106
Mailing address
Ufp - Phalen Village Clinic
1414 Maryland Avenue East
Saint Paul, MN 55106
Phone (651) 772-3461
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 496676700 | Medicaid | MN | |
| A036 | Other | MN | CHAMPUS/TRIWEST |
| 0597575 | Medicaid | IA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | fhmcnorthfield@direct.northfieldhospital.md | Northfield Hospital |
Other providers in Saint Paul, MN
- Michelle Elizabeth Aiad
- Niladri Aichbhaumik
- Aid & Assist Home Services Inc
- Aide Bilingual Services
- Hibo Aidid
- Aim Health Care LLC
- Ain Dah Yung Center
- Zuhur Ainab
- Zeba Aini
- Airborne ABA LLC
All providers in Saint Paul, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.