NPIMap

Individual provider Active NPI

Jennifer Chinyere Madubuko, MD

  • Home Health Agency
  • Bowie, MD
National Provider Identifier
1245887116
Registry record updated Nov 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
R4422 Issued in MD
Practice address
12902 Old Chapel Rd
Bowie, MD 20720-4616
Phone
(240) 334-1121
NPI assigned
Aug 24, 2019
Last updated
Nov 28, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X R4422 MD Primary

Addresses

Primary practice location

12902 Old Chapel Rd
Bowie, MD 20720-4616

Mailing address

12902 Old Chapel Rd
Bowie, MD 20720-4616
Phone (240) 334-1121

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL BOWIE

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R4422MDMDHome Health Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Divine Home Community Services Inc Current Accepting new patients
First Option Health Services Home Health Current Accepting new patients
First Option LLC Home Health PastSince Sep 1, 2019 Accepting new patients

Organizations & group practices 9

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": "1566604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606521600000",
    "number": "1245887116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12902 OLD CHAPEL RD",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207204616",
            "telephone_number": "240-334-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12902 OLD CHAPEL RD",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207204616",
            "telephone_number": "240-334-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADUBUKO",
        "first_name": "JENNIFER",
        "middle_name": "CHINYERE",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-24",
        "last_updated": "2020-11-28",
        "certification_date": "2020-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MD",
            "license": "R4422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "BOWIE",
            "affiliation": "N",
            "address_1": "12902 Old Chapel Rd",
            "city": "Bowie",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207204616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Nov 28, 2020; 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.