Active NPI
Ini Balogun
- Primary Care Nurse Practitioner
- Bowie, MD
National Provider Identifier
1124997713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- R210483
- Practice address
- 4305 Northview Dr
Bowie, MD 20716-2600 - Phone
- (240) 473-9999
- NPI assigned
- Nov 3, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | R210483 | MD | Primary |
Addresses
Primary practice location
4305 Northview Dr
Bowie, MD 20716-2600
Mailing address
10813 Rhodenda PL
Upper Marlboro, MD 20772-4824
Phone (571) 201-9970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R210483 | MD | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1762128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762128000000",
"number": "1124997713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10813 RHODENDA PL",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207724824",
"telephone_number": "571-201-9970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4305 NORTHVIEW DR",
"city": "BOWIE",
"state": "MD",
"postal_code": "207162600",
"telephone_number": "240-473-9999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALOGUN",
"first_name": "INI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-11-03",
"last_updated": "2025-11-03",
"certification_date": "2025-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "MD",
"license": "R210483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.