Ednah Kwamboka Makori, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704258890 Issued in MI

Practice address

756 Pipestone St # 2
Benton Harbor, MI 49022-4845

Phone

(269) 926-8535

NPI assigned

Sep 13, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Not Applicable Not Applicable Not Applicable. Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

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 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Complexcare Medical Group Midwest H PLLCGroup PAC ID 0143737148, 128 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Complexcare Medical Group Midwest H PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1457144933

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  Single Specialty

  Medicare reassignment NPD
• Ibekie Foundation Inc

  • Family Medicine Physician
  • Morocco, IN
  • NPI 1255870655

  MI, Single Specialty

  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lakeland Hospitals at Niles and St Joseph, Inc

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation

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

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1013687946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 E NAPIER AVE",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490227336",
            "telephone_number": "269-308-2925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "756 PIPESTONE ST # 2",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490224845",
            "telephone_number": "269-926-8535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAKORI",
        "first_name": "EDNAH",
        "middle_name": "KWAMBOKA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-13",
        "last_updated": "2021-09-13",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704258890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "N/A",
            "affiliation": "N",
            "address_1": "756 Pipestone St # 2",
            "city": "Benton Harbor",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490224845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NOT APPLICABLE",
            "last_name": "NOT APPLICABLE.",
            "middle_name": "NOT APPLICABLE",
            "prefix": "MS.",
            "credential": "FNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tamara Anna Macharaschwili, LMSW
• Courtney A. Mackay, LLBSW
• Vicente Manuel Madison
• Andrew Ryan Mahler, LMSW
• Lisa Makara, N.P.
• Natalie Tanaka Makumbe
• Caitlyn J Malsch, LMSW
• Linda Mammen, MD
• Brett Maniscalco
• Jared Micheal Maniscalco

• Family Nurse Practitioner in Benton Harbor, MI
• Providers in Benton Harbor, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.