Individual provider Active NPI

Nicole Iheoma Iwuchukwu, MD

  • Internal Medicine Physician
  • Baton Rouge, LA
National Provider Identifier
1114380243
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
90670 Issued in GA
Practice address
5000 Hennessy Blvd
Baton Rouge, LA 70808
Phone
(225) 765-4050
NPI assigned
Apr 5, 2016
Last updated
Jan 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 90670 GA Primary

Addresses

Primary practice location

5000 Hennessy Blvd
Baton Rouge, LA 70808

Mailing address

5354 Reynolds St
Ste 424
Savannah, GA 31405-6011
Phone (257) 655-7272

Other practice location 1

1501 Kings Hwy
Internal Medicine
Shreveport, LA 71103-4228
Phone (318) 813-2528

Other practice location 2

1501 Kings Hwy
Internal Medicine
Shreveport, LA 71103-4228
Phone (318) 813-2528

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address niwuchukwu801814@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20220218001755 GA Practitioner - Internal Medicine 4880980986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Texas Medical School at San Antonio, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chatham Hosptialists, LLCGroup PAC ID 1456456995, 33 clinicians

Practice addresses (Care Compare)

5354 Reynolds St
Suite 424
Savannah, GA 31405-6011
Phone (912) 819-5999

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Chatham Hosptialists, LLC Multi-Specialty CurrentSince Oct 12, 2021 Accepting new patients
Candler Hospital Incorporated Multi-Specialty Past Accepting new patients

Locations

5354 Reynolds St
Ste 424
Savannah, GA 31405
Phone (912) 819-5999

Interoperability endpoints

  • Direct secure messaging: niwuchukwu801814@direct.casso.us.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1114380243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5354 REYNOLDS ST",
            "address_2": "STE 424",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056011",
            "telephone_number": "257-655-7272",
            "fax_number": "225-765-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 HENNESSY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70808",
            "telephone_number": "225-765-4050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Kings Hwy",
            "address_2": "Internal Medicine",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711034228",
            "country_code": "US",
            "telephone_number": "318-813-2528",
            "fax_number": "318-813-2525",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 Kings Hwy",
            "address_2": "Internal Medicine",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711034228",
            "country_code": "US",
            "telephone_number": "318-813-2528",
            "fax_number": "318-813-2525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IWUCHUKWU",
        "first_name": "NICOLE",
        "middle_name": "IHEOMA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-05",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "90670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "niwuchukwu801814@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "niwuchukwu801814@direct.casso.us.com",
            "address_1": "5000 Hennessy Blvd",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "70808",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5000 Hennessy Blvd",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "70808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.