Ebenezer Bodude, RN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

298440 Issued in AZ

Practice address

11225 N 28TH Dr
Phoenix, AZ 85029-5606

Phone

(602) 699-6999

NPI assigned

Aug 27, 2015

Last updated

Oct 25, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

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 IncGroup PAC ID 2062699721, 106 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ebenezer.bodudenp.p1@direct.cbridges.nextgenshare.com

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.

• Community Bridges, Inc.

  dba CBI - Encompass Page Integrated Health Home

  • Adult Mental Health Clinic/Center
  • Page, AZ
  • NPI 1558095315
  Medicare reassignment Care Compare group NPD
• Best Care Health Services Inc

  dba Solutions Home Health

  • Home Health Agency
  • Mesa, AZ
  • NPI 1134599913
  NPD
• Community Bridges, Inc.

  dba Community Psychiatric Emergency Center - Outpatient

  • Community/Behavioral Health Agency
  • Mesa, AZ
  • NPI 1588348775
  NPD
• Community Bridges, Inc.

  dba Community Psychiatric Emergency Center (CPEC)

  • Community/Behavioral Health Agency
  • Mesa, AZ
  • NPI 1891068813
  NPD
• Community Bridges, Inc.

  dba Arizona Bridge to Recovery

  • Substance Abuse Rehabilitation Facility
  • Mesa, AZ
  • NPI 1356461727
  NPD (past)
• Community Bridges, Inc.

  • Community/Behavioral Health Agency
  • Mesa, AZ
  • NPI 1508124488
  NPD (past)

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

{
    "created_epoch": "1440633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1275900060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7067 W JACKRABBIT LN",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853836018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11225 N 28TH DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850295606",
            "telephone_number": "602-699-6999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODUDE",
        "first_name": "EBENEZER",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-08-27",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "298440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Bodlak
• Sarah Bodnar, M.S., CF-SLP
• Gayle B Bodner, PA
• Jeffrey Bodner, MD
• Phillip Bodner, CRNA
• Kay Bodude, MSN, BSN, RN
• Body & Soul Community Counseling Services, LLC
• Body Health Consulting, LLC
• Body Mechanics Medical, PLLC
• Body Mechanics Physical Therapy- High St PLLC

• Psychiatric/Mental Health Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.