KHADRA MOHAMED RN
NPI 1104276070
Nurse Practitioner - Psychiatric/Mental Health in Minneapolis, MN

Q: What is Khadra Mohamed's NPI number?

The NPI number for Khadra Mohamed is 1104276070. It was assigned to this individual provider in the NPPES registry on June 21, 2016.

Q: What is Khadra Mohamed's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Khadra Mohamed was last updated on October 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 21, 2016PECOS Enrolled

2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454(612) 323-0538 Get Directions Write a Review

NPPES record last updated: October 13, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 13, 2023, Aug 31, 2023, Jun 21, 2016 (3 updates tracked since 2016).

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About Khadra Mohamed Rn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KHADRA MOHAMED RN (NPI 1104276070) is an individual psychiatric/mental health provider in Minneapolis, Minnesota, licensed in Minnesota (10672) and active in the NPI registry since June 2016. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104276070

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameKHADRA MOHAMEDCredential: RN

Location Address2450 RIVERSIDE AVEMinneapolis, MN 55454-1450

Mailing Address2450 Riverside Ave.Minneapolis, MN 55454 · (612) 323-0538

Phone(612) 323-0538

Sole ProprietorNo

Enumeration DateJune 21, 2016

Last NPPES UpdateOctober 13, 20233 updates tracked since enumeration

NPPES CertifiedOctober 13, 2023

✔ NPI 1104276070 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in MN · 10672

Also ListedRegistered Nurse · Community HealthTaxonomy 163WC1500X · License R-196969-0 (MN)

2450 RIVERSIDE AVE, Minneapolis, MN 55454

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Khadra Mohamed Rn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Khadra Mohamed reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Fairview Express Care

Same address

Clinic/Center

2450 RIVERSIDE AVE, STE F140
Minneapolis, MN 55454

Reassigned Medicare billing, Minnesota enrollment
3,633 clinicians in this Medicare group

NPI 1841428745 (612) 672-6999

Fairview Health Services

Same address

General Acute Care Hospital

2450 RIVERSIDE AVE, OUTREACH LAB DEPARTMENT
Minneapolis, MN 55454

Reassigned Medicare billing, Minnesota enrollment
4,038 clinicians in this Medicare group

NPI 1316008212 (612) 273-7838

Multicultural Health Services LLC

3.2 mi

Community Health

2330 CENTRAL AVE NE
Minneapolis, MN 55418

Reassigned Medicare billing, Minnesota enrollment
9 clinicians in this Medicare group

NPI 1467717413 (612) 781-1212

Healtheast Medical Research Institute

3.3 mi

Internal Medicine

1700 UNIVERSITY AVE W, 6TH FLOOR WEST
Saint Paul, MN 55104

Reassigned Medicare billing, Minnesota enrollment
2,361 clinicians in this Medicare group

NPI 1508191552 (651) 232-2273

Lifespan Psychiatry And Wellness Limited Liability Limited Partnership

8.8 mi

Psychiatric/Mental Health

3800 AMERICAN BLVD W STE 1500
Bloomington, MN 55431

Reassigned Medicare billing, Minnesota enrollment
2 clinicians in this Medicare group

NPI 1427840313 (206) 250-7034

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55454 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.82 typical visit price

range $56.00 – $168.28

Typical copayment $21.45 (range $14.00 – $42.07)

Most-billed visit code 99203

Established Patient

$98.61 typical visit price

range $18.32 – $138.04

Typical copayment $24.65 (range $4.58 – $34.51)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHELLE IRENE GRAY

Rehabilitation Practitioner