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EBISIE GENETI DERESSA MD
NPI 1265223606
Student in an Organized Health Care Education/Training Program in Minneapolis, MN

Active since May 15, 2025PECOS Enrolled
420 DELAWARE ST SE, MINNEAPOLIS, MN 55455(612) 626-4939 Get Directions Write a Review

NPPES record last updated: May 15, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ebisie Geneti Deressa Md NPPES

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

EBISIE GENETI DERESSA MD (NPI 1265223606) is an individual student in an organized health care education/training program in Minneapolis, Minnesota and active in the NPI registry since May 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1265223606
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameEBISIE GENETI DERESSACredential: MD
Location Address420 DELAWARE ST SEMinneapolis, MN 55455-0341
Mailing Address420 Delaware St Se,, Mmc 395Minneapolis, MN 55455
Phone(612) 626-4939
Sole ProprietorNo
Enumeration DateMay 15, 2025
NPPES CertifiedMay 6, 2025
✔ NPI 1265223606 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
420 DELAWARE ST SE, Minneapolis, MN 55455
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ebisie Geneti Deressa Md 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.

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.

KHALID AMIN MD
Pathology (Anatomic Pathology & Clinical Pathology)
420 DELAWARE ST SE, C463 MAYO MEMORIAL BLDG, MAYO MAIL CODE 76
MINNEAPOLIS, MN 55455
Hennepin County (913) 827-3505
MELISSA RICHARDSON PA-C
Physician Assistant
420 DELAWARE ST SE
MINNEAPOLIS, MN 55455
Hennepin County (612) 273-3000
DR. RAID SAID MOUSA YOUSEF M.D.
Student in an Organized Health Care Education/Training Program
420 DELAWARE ST SE, MMC 11
MINNEAPOLIS, MN 55455
Hennepin County (612) 625-7911
DR. DAVID YOUNG BALSER MD
Physical Medicine & Rehabilitation
420 DELAWARE ST SE
MINNEAPOLIS, MN 55455
Hennepin County (612) 625-2661
ALEXANDER TROESTER
Student in an Organized Health Care Education/Training Program
420 DELAWARE ST SE
MINNEAPOLIS, MN 55455
Hennepin County (612) 625-6483
NIKITHA VOBUGARI MD
Internal Medicine (Hematology & Oncology)
420 DELAWARE ST SE, MMC 480
MINNEAPOLIS, MN 55455
Hennepin County (612) 626-0400
THOMAS HOUGHLAND MD
Student in an Organized Health Care Education/Training Program
420 DELAWARE ST SE
MINNEAPOLIS, MN 55455
Hennepin County (612) 626-5589
DR. ANUSHA L GOPALAM MD
Student in an Organized Health Care Education/Training Program
420 DELAWARE ST SE
MINNEAPOLIS, MN 55455
Hennepin County (612) 625-5454

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ebisie Deressa's NPI number?

The NPI number for Ebisie Deressa is 1265223606. It was assigned to this individual provider in the NPPES registry on May 15, 2025.

Where is Ebisie Deressa located?

Ebisie Deressa practices at 420 Delaware St SE, Minneapolis, MN 55455. The listed phone number is (612) 626-4939.

What is Ebisie Deressa's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Ebisie Deressa enrolled in Medicare?

Yes. Ebisie Deressa is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ebisie Deressa was last updated on May 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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.