NPIMap

Organization Active NPI

Ianua Health, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • North East, MD
National Provider Identifier
1033853213
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
IANUA HEALTH, LLC
Doing business as
KetaMinds
Practice address
14 Rogers Rd Ste 211
North East, MD 21901-3612
Phone
(410) 280-7683
NPI assigned
Apr 25, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

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

Authorized official

Name
Mr. Antonio Pedulla Jr., FNPNPI 1518622455
Title
Owner
Phone
(610) 998-3902

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

14 Rogers Rd Ste 211
North East, MD 21901-3612

Mailing address

2207 Concord Pike # 197
Wilmington, DE 19803-2908
Phone (610) 998-3902

Other practice location 1

680 Fremont Rd
Nottingham, PA 19362-9142
Phone (610) 998-3902

Other names 1

  • KetaMinds Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220518001515 PA Part B Supplier - Clinic/Group Practice 3870970536 Receives reassigned benefits from 1 practitioner
Practice locations: Nottingham, PA
O20231011004054 MD Part B Supplier - Clinic/Group Practice 3870970536 Receives reassigned benefits from 1 practitioner
Practice locations: North East, MD

National Provider Directory

National Provider Directory
Tax ID family
Ianua Health LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684281600000",
    "number": "1033853213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2207 CONCORD PIKE # 197",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198032908",
            "telephone_number": "610-998-3902",
            "fax_number": "610-702-8056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 ROGERS RD STE 211",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219013612",
            "telephone_number": "410-280-7683"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "680 Fremont Rd",
            "address_purpose": "LOCATION",
            "city": "Nottingham",
            "state": "PA",
            "postal_code": "193629142",
            "country_code": "US",
            "telephone_number": "610-998-3902",
            "fax_number": "610-702-8056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IANUA HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-25",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A",
        "authorized_official_last_name": "PEDULLA",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-998-3902",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KetaMinds",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North East, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.