Individual provider Active NPI

Ikechukwu Anele Ohiaeri, M.D.

  • Psychiatry Physician
  • Victorville, CA
National Provider Identifier
1063423903
Registry record updated Mar 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A51835 Issued in CA
Practice address
14344 Cajon St.
Suite 102
Victorville, CA 92392-4301
Phone
(760) 843-0506
NPI assigned
Aug 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A51835 CA Primary

Addresses

Primary practice location

14344 Cajon St.
Suite 102
Victorville, CA 92392-4301

Mailing address

14344 Cajon St.
Suite 102
Victorville, CA 92392-4301
Phone (760) 843-0506

Other identifiers 1

IdentifierTypeStateIssuer
00A518353MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081010000552 CA Practitioner - Psychiatry 0547357691 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Foothill Behavioral Health Consultants IncGroup PAC ID 9739276882, 11 clinicians

Practice addresses (Care Compare)

15434 W Sage St
Suite 101
Victorville, CA 92392-9708
Phone (760) 843-0506

Hospital & facility affiliations

  • Victor Valley Global Medical Center Hospital, Victorville, CA, CCN 050517
  • Providence St Mary Medical Center Hospital, Apple Valley, CA, CCN 050300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A51835CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Conscious Behavioral Health, a Medical Corporation Psychiatry Current Accepting new patients
Foothill Behavioral Health Consultants Inc Psychiatry CurrentSince Jun 1, 1999 Accepting new patients
Savanna Olsson, Pmhnp: a Professional Nursing Corporation PastSince Feb 24, 2022 Accepting new patients

Locations

2335 S Towne Ave
Pomona, CA 91766
Phone (760) 843-0506

15434 W Sage St
Victorville, CA 92392
Phone (760) 563-2875

15434 W Sage St
Ste 101
Victorville, CA 92392
Phone (760) 843-0506

16519 Victor St
Ste 406
Victorville, CA 92395
Phone (760) 843-0506

14344 Cajon Ave
Ste 102
Victorville, CA 92392
Phone (760) 243-3999

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364256000000",
    "number": "1063423903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14344 CAJON ST.",
            "address_2": "SUITE 102",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923924301",
            "telephone_number": "760-843-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14344 CAJON ST.",
            "address_2": "SUITE 102",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923924301",
            "telephone_number": "760-843-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OHIAERI",
        "first_name": "IKECHUKWU",
        "middle_name": "ANELE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2013-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A51835",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A518353",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.