Individual provider Active NPI

Promise Ihuoma Amadi

  • Primary Care Nurse Practitioner
  • Bowie, MD
National Provider Identifier
1205503208
Registry record updated Aug 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
F12200304 Issued in MD
Practice address
2615 Lady Grove Rd
Bowie, MD 20721-4126
Phone
(301) 775-6257
NPI assigned
Aug 26, 2021
Last updated
Aug 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X F12200304 MD Primary

Addresses

Primary practice location

2615 Lady Grove Rd
Bowie, MD 20721-4126

Mailing address

2615 Lady Grove Rd
Bowie, MD 20721-4126
Phone (301) 775-6257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F12200304MDMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prince George's County Health Department Current Accepting new patients

Locations

3003 Hospital Dr
Hyattsville, MD 20785
Phone (301) 583-3340

1701 McCormick Dr
Ste 102
Upper Marlboro, MD 20774

1701 McCormick Dr
Ste 120
Upper Marlboro, MD 20774

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": "1629936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1205503208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 LADY GROVE RD",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207214126",
            "telephone_number": "301-775-6257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 LADY GROVE RD",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207214126",
            "telephone_number": "301-775-6257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMADI",
        "first_name": "PROMISE",
        "middle_name": "IHUOMA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-26",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MD",
            "license": "F12200304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.