David Jessie Idemudia, LCSW-C

Primary specialty

Social WorkerTaxonomy code 104100000X

License

24208 Issued in MD

Practice address

200 Hospital Dr Ste 300
Glen Burnie, MD 21061-5884

Phone

(410) 837-2050

NPI assigned

Feb 1, 2020

Sex

Male

Sole proprietor

No

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 MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Chase Brexton Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Baltimore, MD
  • NPI 1588606305
  Medicare reassignment NPD
• Chase Brexton Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Columbia, MD
  • NPI 1376589309
  NPD

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

{
    "created_epoch": "1580515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633046400000",
    "number": "1255962841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL DR STE 500",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615887",
            "telephone_number": "410-837-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL DR STE 300",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615884",
            "telephone_number": "410-837-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDEMUDIA",
        "first_name": "DAVID",
        "middle_name": "JESSIE",
        "credential": "LCSW-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-01",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MD",
            "license": "24208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Marie Huyssoon, MS CCC-SLP
• Nanhe Hwang
• Kara Beth Iacovella, CRNP-PMH
• Mary Jo Iacovelli, RN
• Ibrahim-Smilekeepers Dental
• Adaku Chinenye Idika, MD
• Otibhor Igene, MD
• Susan Osadebawen Ighekpe
• Ronaldo Victorino Asuncion Ignacio
• Rabea Ilahe

• Social Worker in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.