Jodelle Ingram

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

310492 Issued in NY

Practice address

612 Allerton Ave
Bronx, NY 10467-7404

Phone

(718) 519-4125

NPI assigned

Oct 14, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1634169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1083377352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 ALLERTON AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104677404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 ALLERTON AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104677404",
            "telephone_number": "718-519-4125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "JODELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-14",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NY",
            "license": "310492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Nicole Ingenita
• Kogie Johnson Ingersoll
• Karen Inghilterra, M.D.
• Michael M Ingino, PT
• Barry Ingram, PT
• Mark Ingram
• Katherine Rose Ingrasci, MS, CCC-SLP
• Marian M Inguanzo, LMSW
• Ravali Reddy Inja, MD
• Inna Ross' Kids Inc

• Primary Care Nurse Practitioner in Bronx, NY
• Providers in Bronx, NY by specialty
• Primary Care Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.