Active NPI
Isaac Ndungu, CNP
- Gerontology Nurse Practitioner
- West Springfield, MA
National Provider Identifier
1174900690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- RN2283072
- Practice address
- 103 Myron St
Suite a
West Springfield, MA 01089-1598 - Phone
- (413) 592-1980
- Fax
- (413) 439-0100
- NPI assigned
- May 5, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN2283072 | MA | |
| Gerontology Nurse Practitioner | 363LG0600X | RN2283072 | MA | Primary |
Addresses
Primary practice location
103 Myron St
Suite a
West Springfield, MA 01089-1598
Mailing address
103 Myron St
Suite a
West Springfield, MA 01089-1598
Phone (413) 592-1980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA, MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
10 Griffin St
Haverhill, MA 01832-1312
3934 Red Deer Cir
Randallstown, MD 21133-2047
706 Ferry St
East Dublin, GA 31027-7450
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN2283072 | MA | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prosper Health and Behavioral Care Services | Current | Accepting new patients | |
| Prosper Health and Behavioral Care Services | Current | Accepting new patients | |
| Center State Wellness LLC | Current | Accepting new patients | |
| Center State Wellness LLC | Current | Accepting new patients |
Organizations & group practices 4
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.
-
- Psychiatry Physician
- Windsor Mill, MD
- NPI 1801572722
-
- Psychiatric/Mental Health Nurse Practitioner
- Concord, NH
- NPI 1215646039
-
- Family Nurse Practitioner
- Concord, NH
- NPI 1689235319
-
- Psychiatry Physician
- Windsor Mill, MD
- NPI 1588400030
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430784000000",
"number": "1174900690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 MYRON ST",
"address_2": "SUITE A",
"city": "WEST SPRINGFIELD",
"state": "MA",
"postal_code": "010891598",
"telephone_number": "413-592-1980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 MYRON ST",
"address_2": "SUITE A",
"city": "WEST SPRINGFIELD",
"state": "MA",
"postal_code": "010891598",
"telephone_number": "413-592-1980",
"fax_number": "413-439-0100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NDUNGU",
"first_name": "ISAAC",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-05-05",
"last_updated": "2015-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MA",
"license": "RN2283072",
"primary": false
},
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "MA",
"license": "RN2283072",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in West Springfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; 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.