Igbinoghodua Jonathan Edomwonyi, MSN, PMHNP-BC.

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11032287 Issued in FL

Practice address

3800 W Broward Blvd Ste 101
Fort Lauderdale, FL 33312-1018

Phone

(954) 271-0291

NPI assigned

May 20, 2024

Sex

Male

Sole proprietor

Yes

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 FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: igbinoghodua.edomwonyi.1@29801.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/23897/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prestige Recovery and Suboxone Clinic LLC

  dba Prestige Concierge Psychiatry

  • Psychiatry Physician
  • Fort Lauderdale, FL
  • NPI 1215623624
  Medicare reassignment NPD
• Prestige Clinicians LLC

  • Primary Care Clinic/Center
  • Oakland Park, FL
  • NPI 1497213755
  NPD

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

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1235978297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 W BROWARD BLVD STE 101",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333121018",
            "telephone_number": "954-271-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 W BROWARD BLVD STE 101",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333121018",
            "telephone_number": "954-271-0291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDOMWONYI",
        "first_name": "IGBINOGHODUA",
        "middle_name": "JONATHAN",
        "name_prefix": "Mr.",
        "credential": "MSN, PMHNP-BC.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11032287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Bruce Edison, M.D.
• Sandjaya Edmond
• Sandy H. Edmonds
• Dana Renee Edmundson
• Michael Ednie, M.D.
• Eduardo J Hidalgo MD PA
• Edward a Dauer MD PA (Florida Medical Radiology Associates)
• Edward N. Smolar, MD PA
• Edward S Walker MD PA
• Brittlee Edwards, CRT

• Psychiatric/Mental Health Nurse Practitioner in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.