Ebenezer Bodude, RN
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Phoenix, AZ
NPI 1275900060 · NPPES record last updated Oct 25, 2023
Key facts
- NPI
- 1275900060
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 298440 (AZ)
- Practice address
- 11225 N 28TH Dr
Phoenix, AZ 85029-5606 - Phone
- (602) 699-6999
- NPI assigned
- Aug 27, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Community Bridges Inc
Practice addresses (Care Compare)
824 N 99TH Ave
Suite 107And108
Avondale, AZ 85323-5324
Phone (623) 907-1457
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231228000304 | AZ | Practitioner - Nurse Practitioner | 1456651090 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Best Care Health Services Inc | Current | Accepting new patients | |
| Community Bridges, Inc. | Current |
Accepting new patients | |
| Community Bridges, Inc. | Current |
Accepting new patients | |
| Community Bridges, Inc. | Current | Accepting new patients | |
| Community Bridges, Inc. | Past | Accepting new patients | |
| Community Bridges, Inc. | Past | Accepting new patients |
Locations
824 N 99th Ave
Ste 109
Avondale, AZ 85323
Phone (623) 907-1457
824 N 99th Ave
Ste 105
Avondale, AZ 85323
Phone (602) 545-8247
824 N 99th Ave
Ste 107108
Avondale, AZ 85323
Phone (623) 907-1457
1855 W Baseline Rd
Ste 101
Mesa, AZ 85202
2770 E Van Buren St
Rm Abd
Phoenix, AZ 85008
Phone (602) 273-9999
Interoperability endpoints
- ebenezer.bodudenp.p1@direct.cbridges.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 298440 | AZ | Yes |
Addresses
Primary practice location
11225 N 28TH Dr
Phoenix, AZ 85029-5606
Mailing address
7067 W Jackrabbit LN
Peoria, AZ 85383-6018
Other providers in Phoenix, AZ
- Diane E Bodjanac
- Tara Bodlak
- Sarah Bodnar
- Gayle B Bodner
- Jeffrey Bodner
- Kay Bodude
- Body & Soul Community Counseling Services, LLC
- Body Health Consulting, LLC
- Body Mechanics Medical, PLLC
- Body Mechanics Physical Therapy- High St PLLC
All providers in Phoenix, AZ · Psychiatric/Mental Health Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.