Individual provider Active NPI

Ahamefule Epoh

  • Psychiatric/Mental Health Nurse Practitioner
  • Long Beach, CA
National Provider Identifier
1174285852
Registry record updated Oct 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95017733 Issued in CA
Practice address
5901 E 7TH St # T1
Long Beach, CA 90822-5201
Phone
(562) 826-8000
NPI assigned
Oct 9, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95017733 CA Primary

Addresses

Primary practice location

5901 E 7TH St # T1
Long Beach, CA 90822-5201

Mailing address

5901 E 7TH St # T1
Long Beach, CA 90822-5201
Phone (562) 826-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220818000479 CA Practitioner - Nurse Practitioner 4486037801 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95017733CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mellow Medical Inc a Professional Corporation CurrentSince Jul 13, 2022 Accepting new patients

Locations

12301 Wilshire Blvd
Ste 512
Los Angeles, CA 90025
Phone (833) 427-3566

5201 Great America Pkwy
Ste 320
Santa Clara, CA 95054
Phone (323) 968-6182

8235 Santa Monica Blvd
Ste 302
West Hollywood, CA 90046
Phone (310) 892-4284

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9357/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1633737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633737600000",
    "number": "1174285852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 E 7TH ST # T1",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908225201",
            "telephone_number": "562-826-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 E 7TH ST # T1",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908225201",
            "telephone_number": "562-826-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EPOH",
        "first_name": "AHAMEFULE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-09",
        "last_updated": "2021-10-09",
        "certification_date": "2021-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95017733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.