Active NPI
Ethylien Ndum
- Community/Behavioral Health Agency
- Washington, DC
National Provider Identifier
1023767522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Practice address
- 2600 Bryan PL SE
Washington, DC 20020-4417 - Phone
- (202) 894-6811
- NPI assigned
- Mar 22, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Home Health Aide | 374U00000X | HHA15705 | DC | |
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
2600 Bryan PL SE
Washington, DC 20020-4417
Mailing address
5078 Silver Hill CT Apt 104
Forestville, MD 20747-2029
Phone (240) 486-7460
Other practice location 1
2501 Good Hope Rd SE
Washington, DC 20020-3011
Phone (202) 866-7505
Other practice location 2
4660 Martin Luther King Jr Ave SW
Washington, DC 20032-4933
Phone (240) 486-7460
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HHA15705 | DC | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687824000000",
"number": "1023767522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5078 SILVER HILL CT APT 104",
"city": "FORESTVILLE",
"state": "MD",
"postal_code": "207472029",
"telephone_number": "240-486-7460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 BRYAN PL SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200204417",
"telephone_number": "202-894-6811"
}
],
"practiceLocations": [
{
"address_1": "2501 Good Hope Rd SE",
"address_purpose": "LOCATION",
"city": "Washington",
"state": "DC",
"postal_code": "200203011",
"country_code": "US",
"telephone_number": "202-866-7505",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4660 Martin Luther King Jr Ave SW",
"address_purpose": "LOCATION",
"city": "Washington",
"state": "DC",
"postal_code": "200324933",
"country_code": "US",
"telephone_number": "240-486-7460",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NDUM",
"first_name": "ETHYLIEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-22",
"last_updated": "2023-06-27",
"certification_date": "2023-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "DC",
"license": "HHA15705",
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.