Active NPI
Mohamed Ali Mohamed
- Behavior Technician
- Saint Louis Park, MN
National Provider Identifier
1851003578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 4236 Park Glen Rd
Saint Louis Park, MN 55416-4758 - Phone
- (052) 888-7055
- Fax
- (612) 605-3312
- NPI assigned
- Dec 14, 2022
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
4236 Park Glen Rd
Saint Louis Park, MN 55416-4758
Mailing address
4236 Park Glen Rd
Saint Louis Park, MN 55416-4758
Phone (952) 888-7055
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iska Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Developmentally Disabled Services Day Training Agency
- St Louis, MN
- NPI 1053772939
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670976000000",
"number": "1851003578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4236 PARK GLEN RD",
"city": "SAINT LOUIS PARK",
"state": "MN",
"postal_code": "554164758",
"telephone_number": "952-888-7055",
"fax_number": "612-605-3312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4236 PARK GLEN RD",
"city": "SAINT LOUIS PARK",
"state": "MN",
"postal_code": "554164758",
"telephone_number": "052-888-7055",
"fax_number": "612-605-3312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHAMED",
"first_name": "MOHAMED",
"middle_name": "ALI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-12-14",
"last_updated": "2022-12-14",
"certification_date": "2022-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.