NPIMap

Individual provider Active NPI

Chukwuma Ebo

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1275548729
Registry record updated May 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0061907 Issued in MD
Practice address
1124 Mace Ave
Baltimore, MD 21221-3315
Phone
(410) 391-6996
Fax
(410) 687-6877
NPI assigned
Jul 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 30, 2018

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 D0061907 MD Primary

Addresses

Primary practice location

1124 Mace Ave
Baltimore, MD 21221-3315

Mailing address

1124 Mace Ave
Baltimore, MD 21221-3315
Phone (410) 391-6996

Other identifiers 1

IdentifierTypeStateIssuer
407505600MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040916000893 MD Practitioner - Internal Medicine 3476520537 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mace Medical LLCGroup PAC ID 8123308020, 15 clinicians
Agape Physical Therapy and Sports Rehabilitation LPGroup PAC ID 3870741390, 684 clinicians

Practice addresses (Care Compare)

1124 Mace Ave
Baltimore, MD 21221-3315
Phone (410) 391-6996

12 Newport Dr
Suite a
Forest Hill, MD 21050-1758

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0061907MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mace Medical LLC Internal Medicine CurrentSince Jan 1, 2017 Accepting new patients
Sciometrix Inc CurrentSince Jul 15, 2024 Accepting new patients
Sciometrix LLC PastSince Oct 10, 2021 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

2800 Sollers Point Rd
Dundalk, MD 21222
Phone (410) 391-6996

1124 Mace Ave
Essex, MD 21221
Phone (410) 391-6996

15005 Shady Grove Rd
Ste 240
Rockville, MD 20850
Phone (301) 217-0979

306 S Washington Ave
Ste 600
Royal Oak, MI 48067

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JHCFBA

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Medstar Franklin Square Medical CenterBaltimore, MD, CCN 210015 Hospital Corporate Director Nov 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 7

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": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527638400000",
    "number": "1275548729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 MACE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212213315",
            "telephone_number": "410-391-6996",
            "fax_number": "410-687-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 MACE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212213315",
            "telephone_number": "410-391-6996",
            "fax_number": "410-687-6877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBO",
        "first_name": "CHUKWUMA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-30",
        "last_updated": "2018-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0061907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407505600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.