Active NPI
Promise Ihuoma Amadi
- Primary Care Nurse Practitioner
- Bowie, MD
National Provider Identifier
1205503208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- F12200304
- Practice address
- 2615 Lady Grove Rd
Bowie, MD 20721-4126 - Phone
- (301) 775-6257
- NPI assigned
- Aug 26, 2021
- Last updated
- Aug 26, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| F12200304 | MD | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New 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.
-
dba General Clinics
- Public Health or Welfare Agency
- Cheverly, MD
- NPI 1366711947
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.