Ikechukwu Uchenna Mbagwu, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

4351048707 Issued in MI

Practice address

3031 W Grand Blvd Ste 600
Detroit, MI 48202-3014

Phone

(313) 346-5235

NPI assigned

May 6, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Psychiatry

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Newaygo County Mental Health Board 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mikechukwu762657@direct.hfhs.org
• Direct secure messaging: ikechukwu.mbagwu.1@19827.direct.athenahealth.com

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.

• Newaygo County Mental Health Board

  • Community/Behavioral Health Agency
  • White Cloud, MI
  • NPI 1376512236

  MI, Psychiatry

  Medicare reassignment Care Compare group NPD
• Newaygo County Mental Health Board

  • Psychiatry Physician
  • White Cloud, MI
  • NPI 1386969996

  Psychiatry

  NPD

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

{
    "created_epoch": "1620259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1124602040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 W GRAND BLVD STE 600",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023014",
            "telephone_number": "313-871-3751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 W GRAND BLVD STE 600",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023014",
            "telephone_number": "313-346-5235"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22250 Providence Dr.",
            "address_2": "3PMB Suite #301",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "48075",
            "country_code": "US",
            "telephone_number": "248-849-3281",
            "fax_number": "248-849-5449",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MBAGWU",
        "first_name": "IKECHUKWU",
        "middle_name": "UCHENNA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-06",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4351048707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robin Marie Mazur, NP
• Levi Francis Mazza
• Kaitlyn Mazzanti, NP
• Paul F Mazzara, MD
• Alexandria Mazzeo, BSW
• Janessa Mbagwu, DO
• Raymond Tamambang Mbah, MD
• Chineze Ekilisie Mbanugo, MD
• Bernard Asonganyi Mbeboh, MD
• Alyson McAdams

• All providers in Detroit, MI
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.