Maurice A Ajaifia, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Grand Ronde, OR
NPI 1083288682 · NPPES record last updated Jan 9, 2024
Key facts
- NPI
- 1083288682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 10014932 (OR)
- Practice address
- 9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712 - Phone
- (503) 879-2026
- NPI assigned
- May 18, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Confederated Tribes of the Grand Ronde Community of Oregon
Practice addresses (Care Compare)
9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712
9615 Grand Ronde Rd
Grand Ronde, OR 97347-9712
Phone (503) 879-2007
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240726002865 | OR | Practitioner - Nurse Practitioner | 4880130731 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10014932 | OR | MD | Psychiatric/Mental Health Nurse Practitioner |
| AP61391953 | WA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Confederated Tribes of the Grand Ronde Community of Oregon | Current |
Accepting new patients | |
| Confederated Tribes of the Grand Ronde Community of Oregon | Current |
Accepting new patients | |
| Confederated Tribes of Grand Ronde Community of Oregon Dba GR Health & | Past | Accepting new patients | |
| Lifeline Connections | Past |
Accepting new patients |
Locations
9605 Grand Ronde Rd
Grand Ronde, OR 97347
Phone (503) 879-2002
9615 Grand Ronde Rd
Grand Ronde, OR 97347
Phone (503) 879-2002
Interoperability endpoints
- maurice.ajaifia.p1@direct.grandronde.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | AP61391953 | WA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 10014932 | OR | Yes |
Addresses
Primary practice location
9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712
Mailing address
9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712
Phone (503) 879-2060
Other practice location 1
5197 NW Lower River Rd
Vancouver, WA 98660
Phone (360) 397-8246
Other providers in Grand Ronde, OR
All providers in Grand Ronde, OR · Psychiatric/Mental Health Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.