Jacqueline Mbuagbaw Fosah

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP145962 Issued in TX

Practice address

1504 Ben Taub Loop
Houston, TX 77030

Phone

(712) 873-2000

NPI assigned

Aug 6, 2020

Sex

Female

Sole proprietor

Yes

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 TX

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Eleanor Health Professional TX, PLLCGroup PAC ID 9335527118, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacqueline.fosah.1@21505.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/2717/brand/21/csg/1/fhir/r4

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.

• Eleanor Health Professional TX, PLLC

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • San Antonio, TX
  • NPI 1932854981
  Medicare reassignment Care Compare group NPD
• Houston Sleep and Narcolepsy PLLC

  • Sleep Disorder Diagnostic Clinic/Center
  • Cypress, TX
  • NPI 1992329395
  Medicare reassignment NPD
• Kinghaven Counseling Group Inc

  • Case Management Agency
  • Houston, TX
  • NPI 1396807350
  Medicare reassignment NPD
• Eleanor Health Professional TX, PLLC

  • Addiction Psychiatry Physician
  • Denver, CO
  • NPI 1891583480
  NPD

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

{
    "created_epoch": "1596672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596672000000",
    "number": "1164032975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5635 W HARROW DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770841869",
            "telephone_number": "651-398-2927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 BEN TAUB LOOP",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77030",
            "telephone_number": "712-873-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOSAH",
        "first_name": "JACQUELINE",
        "middle_name": "MBUAGBAW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-06",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP145962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Forum Healthcare Clinic Inc.
• Forward Faith Behavioral Services
• Forward Mobile Medics, LLC
• Forward Path DX Lab LLC
• Forward Thinking LLC
• Margaret Jeanette Foss, ACC
• Prisila A Foss, M.D.
• Frank V. Fossella, M.D.
• Maream Fosshat, PHARMD
• Madeline Margaret Fossitt

• Psychiatric/Mental Health Nurse Practitioner in Houston, TX
• Providers in Houston, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; 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.