Individual provider Active NPI

Ikechi F Okwara, MD

  • Internal Medicine Physician
  • Glenn Dale, MD
National Provider Identifier
1265472567
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D43351 Issued in MD
Practice address
12200 Annapolis Rd
Ste 316
Glenn Dale, MD 20769-9182
Phone
(301) 313-0600
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D43351 MD Primary

Addresses

Primary practice location

12200 Annapolis Rd
Ste 316
Glenn Dale, MD 20769-9182

Mailing address

3815 Deep Hollow Way
Bowie, MD 20721-1275
Phone (301) 313-0600

Other identifiers 4

IdentifierTypeStateIssuer
130271000MedicaidMD
409972900MedicaidMD
75859903OtherMDBLUE SHIELD
P00433571OtherMDRAILROAD MED

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040414001398 MD Practitioner - Internal Medicine 1850385428 Reassigns benefits to 1 organization
I20071030000147 DC Practitioner - Internal Medicine 1850385428 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inclusive Health CorporationGroup PAC ID 9830379320, 2 clinicians

Practice addresses (Care Compare)

12200 Annapolis Rd
Glenn Dale, MD 20769-9182
Phone (301) 313-0600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D43351MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Inclusive Health Corporation CurrentSince Sep 1, 2010 Accepting new patients
Largo Nursing and Rehabilitation Center LLC Past Accepting new patients
Emc Emergency Physicians PastSince Jan 1, 1990 Accepting new patients
Metropolitan Physicians Group LLC Internal Medicine Past Accepting new patients
Emc Emergency Physicians PastSince Jan 1, 1990 Accepting new patients
Medlantic Healthcare Group, Inc. PastSince Jan 1, 1990 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

12200 Annapolis Rd
Ste 316
Glenn Dale, MD 20769
Phone (301) 313-0600

Organizations & group practices 7

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321574400000",
    "number": "1265472567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 DEEP HOLLOW WAY",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207211275",
            "telephone_number": "301-313-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 ANNAPOLIS RD",
            "address_2": "STE 316",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699182",
            "telephone_number": "301-313-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKWARA",
        "first_name": "IKECHI",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2011-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D43351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130271000",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409972900",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "75859903",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MED",
            "identifier": "P00433571",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenn Dale, MD

Sources for this page

Verify at the official NPI Registry.