Individual provider Active NPI

Ifeoma Erica Obumneme-Akaneme

  • Family Nurse Practitioner
  • Mount Vernon, NY
National Provider Identifier
1184288045
Registry record updated Apr 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F344321-1 Issued in NY
Practice address
153 Stevens Ave Ste 4
Mount Vernon, NY 10550-2543
Phone
(718) 219-1703
NPI assigned
Apr 25, 2019
Last updated
Apr 25, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F344321-1 NY Primary

Addresses

Primary practice location

153 Stevens Ave Ste 4
Mount Vernon, NY 10550-2543

Mailing address

1136 E 224TH St
Bronx, NY 10466-5835
Phone (718) 219-1703

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20210324002477 NY Practitioner - Nurse Practitioner 4587071261 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F344321-1NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Group of New York, P.C. Family CurrentSince Jan 27, 2021 Accepting new patients

Locations

107 S Country Rd
Bellport, NY 11713
Phone (631) 286-2222

7960 Metropolitan Ave
Middle Village, NY 11379
Phone (718) 326-4910

241 W 57th St
New York, NY 10019
Phone (212) 247-5848

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, 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": "1556150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556150400000",
    "number": "1184288045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 E 224TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104665835",
            "telephone_number": "718-219-1703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 STEVENS AVE STE 4",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105502543",
            "telephone_number": "718-219-1703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBUMNEME-AKANEME",
        "first_name": "IFEOMA",
        "middle_name": "ERICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-25",
        "last_updated": "2019-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F344321-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, NY

Sources for this page

Verify at the official NPI Registry.