Individual provider Active NPI

Isaac Ndungu, CNP

  • Gerontology Nurse Practitioner
  • West Springfield, MA
National Provider Identifier
1174900690
Registry record updated May 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
RN2283072 Issued in MA
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

Updated by the provider on May 5, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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, MD2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150622002598 MA Practitioner - Nurse Practitioner 6709197494
I20250820005208 MD Practitioner - Nurse Practitioner 6709197494 Reassigns benefits to 1 organization

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

LicenseStateTypeSpecialty
RN2283072MAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prosper Health and Behavioral Care Services CurrentSince Jul 1, 2025 Accepting new patients
Prosper Health and Behavioral Care Services CurrentSince Jul 1, 2025 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.

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

Verify at the official NPI Registry.