Individual provider Active NPI

Abena F Amponsah, FNP-BC

  • Nurse Practitioner
  • Saint Joseph, MI
National Provider Identifier
1114529484
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704245134 Issued in MI
Practice address
4025 Health Park LN
Saint Joseph, MI 49085-3421
Phone
(269) 429-7100
Fax
(269) 429-1307
NPI assigned
Nov 12, 2020
Last updated
Aug 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704245134 MI Primary

Addresses

Primary practice location

4025 Health Park LN
Saint Joseph, MI 49085-3421

Mailing address

4025 Health Park LN
Saint Joseph, MI 49085-3421
Phone (269) 429-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210203000232 MI Practitioner - Nurse Practitioner 9335553304 Reassigns benefits to 2 organizations
I20221103000723 IN Practitioner - Nurse Practitioner 9335553304 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Rehab Consultants LLCGroup PAC ID 7810184892, 162 clinicians

Practice addresses (Care Compare)

1101 E Coolspring Ave
Michigan City, IN 46360-6310
Phone (219) 874-5211

3905 Lorraine Path
Saint Joseph, MI 49085-8630
Phone (269) 428-1111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Rehab Consultants LLC CurrentSince Apr 1, 2022 Accepting new patients
Integrated Rehab Consultants LLC CurrentSince Apr 1, 2022 Accepting new patients
Hospice at Home, Inc. CurrentSince Aug 29, 2021 Accepting new patients

Locations

1260 City Center Dr
Carmel, IN 46032
Phone (463) 333-9110

950 Park East Blvd
Lafayette, IN 47905
Phone (765) 237-5613

1101 E Coolspring Ave
Michigan City, IN 46360
Phone (219) 874-5211

2400 Silhavy Rd
Valparaiso, IN 46383
Phone (219) 462-1778

1014 E Grand River Ave
Brighton, MI 48116
Phone (810) 220-5222

3905 Lorraine Path
Saint Joseph, MI 49085
Phone (248) 428-1111

4025 Health Park Ln
Saint Joseph, MI 49085
Phone (269) 429-7100

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1114529484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 HEALTH PARK LN",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853421",
            "telephone_number": "269-429-7100",
            "fax_number": "269-429-1307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 HEALTH PARK LN",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853421",
            "telephone_number": "269-429-7100",
            "fax_number": "269-429-1307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMPONSAH",
        "first_name": "ABENA",
        "middle_name": "F",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-12",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704245134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

Verify at the official NPI Registry.