Individual provider Active NPI

Rana Dakdouk, CNS

  • Nutrition Education Nutritionist
  • Duluth, MN
National Provider Identifier
1790319705
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nutrition Education NutritionistTaxonomy code 133NN1002X
License
N241 Issued in MN
Practice address
420 E 1St St
Duluth, MN 55805-1901
Phone
(218) 786-8364
NPI assigned
Feb 28, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nutritionist 133N00000X PA
Nutrition Education Nutritionist 133NN1002X PA
Nutrition Education Nutritionist 133NN1002X N241 MN Primary

Addresses

Primary practice location

420 E 1St St
Duluth, MN 55805-1901

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240405000256 PA Practitioner - Registered Dietitian Or Nutrition Professional 1254755978 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Simplex HealthGroup PAC ID 8022354182, 23 clinicians

Practice addresses (Care Compare)

300 Brookside Ave
Suite 125
Ambler, PA 19002-3436
Phone (877) 842-2425

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist

State licenses

LicenseStateTypeSpecialty
N241MNMDNutrition Education Nutritionist

Practice roles

OrganizationSpecialtyStatusNew patients
Simplex Health CurrentSince Feb 24, 2024 Accepting new patients
Adrian Chiu, PH.D., PLLC PastSince Dec 1, 2023 Accepting new patients

Locations

300 Brookside Ave
Ste 180
Ambler, PA 19002
Phone (484) 450-8488

300 Brookside Ave
Bldg 4
Ambler, PA 19002
Phone (267) 702-4862

300 Brookside Ave
Bldg 18
Ambler, PA 19002
Phone (877) 842-2425

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1582848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1790319705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051901",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAKDOUK",
        "first_name": "RANA",
        "name_prefix": "Ms.",
        "credential": "CNS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-28",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "MN",
            "license": "N241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.