Daniel Ezidiegwu Jr.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

H91622 Issued in MD

Practice address

1130 Annapolis Rd Ste 100
Odenton, MD 21113-1622

Phone

(410) 672-2255

Fax

(410) 672-2275

NPI assigned

Apr 25, 2017

Last updated

Jun 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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 MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physical Medicine and Rehabilitation

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Greater Maryland Pain Management, LLCGroup PAC ID 4486881513, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Greater Maryland Pain Management, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Odenton, MD
  • NPI 1710312723
  Medicare reassignment Care Compare group NPD
• Checkerspot Surgery Centers, LLC

  • Ambulatory Surgical Clinic/Center
  • Odenton, MD
  • NPI 1447685458
  Medicare reassignment NPD (past)
• Greater Maryland Pain Management, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Annapolis, MD
  • NPI 1346135902
  NPD

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

{
    "created_epoch": "1493078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1184159444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 ANNAPOLIS RD STE 100",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131622",
            "telephone_number": "410-672-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 ANNAPOLIS RD STE 100",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131622",
            "telephone_number": "410-672-2255",
            "fax_number": "410-672-2275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7845 Oakwood Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Glen Burnie",
            "state": "MD",
            "postal_code": "210614257",
            "country_code": "US",
            "telephone_number": "410-648-2439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EZIDIEGWU",
        "first_name": "DANIEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-25",
        "last_updated": "2023-06-28",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MD",
            "license": "H91622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emc Pharmacy Inc (Emc Care Pharmacy)
• Gloria Chimankpam Emmanuel-Ekunno
• Lisa Ennis
• Ufuoma Splendour Eriekpare
• Hope Evans
• Savannah Fabius
• Fairlife Healthcare, LLC
• Fairlife Support Solutions, Inc.
• Olubukola Fakunle, PHARM.D
• Oluwateniola Faleti, BT

• Physical Medicine & Rehabilitation Physician in Odenton, MD
• Providers in Odenton, MD by specialty
• Physical Medicine & Rehabilitation Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; 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.