Individual provider Active NPI

Stella Ijiyode, FNP-C

  • Family Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1013405091
Registry record updated Aug 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R149850 Issued in MD
Practice address
1111 N Charles St
Baltimore, MD 21201-5505
Phone
(410) 837-2050
NPI assigned
Apr 25, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 23617 TN
Family Nurse Practitioner 363LF0000X R149850 MD Primary

Addresses

Primary practice location

1111 N Charles St
Baltimore, MD 21201-5505

Mailing address

1111 N Charles St
Baltimore, MD 21201-5505
Phone (410) 837-2050

Other identifiers 1

IdentifierTypeStateIssuer
101405516OtherTNTN DRIVER LICENCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201105000889 DC Practitioner - Nurse Practitioner 6608129044 Reassigns benefits to 1 organization
I20210302000448 MD Practitioner - Nurse Practitioner 6608129044

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MNR Industries, LLCGroup PAC ID 7416908843, 142 clinicians

Practice addresses (Care Compare)

1505 E Churchville Rd
Bel Air, MD 21014-4742

2401 E Belvedere Ave
Baltimore, MD 21215-5216

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
23617TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MNR Industries LLC Current Accepting new patients
MNR Industries, LLC CurrentSince Jun 1, 2025 Accepting new patients
MNR Industries,LLC CurrentSince Jun 1, 2025 Accepting new patients
MNR Industries, LLC Current Accepting new patients
MNR Industries, LLC CurrentSince Jun 1, 2025 Accepting new patients
MNR Industries, LLC Current Accepting new patients
Viewpoint Wellness LLC PastSince Mar 1, 2021 Accepting new patients
Post Acute Health Care Services LLC Past Accepting new patients

Locations

1505 E Churchville Rd
#A
Bel Air, MD 21014
Phone (410) 420-6970

1505 E Churchville Rd
Bel Air, MD 21014
Phone (410) 420-6970

6000 Laurel Bowie Rd
Bowie, MD 20715
Phone (301) 383-0330

504 E Ridgeville Blvd
#A
Mount Airy, MD 21771
Phone (301) 703-5452

Organizations & group practices 8

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": "1524614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1013405091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015505",
            "telephone_number": "410-837-2050",
            "fax_number": "866-629-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015505",
            "telephone_number": "410-837-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IJIYODE",
        "first_name": "STELLA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-25",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "23617",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R149850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN DRIVER LICENCE",
            "identifier": "101405516",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.