Individual provider Active NPI

Jane Ngozi Iwebo, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Salisbury, MD
National Provider Identifier
1285296384
Registry record updated Sep 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R128087 Issued in MD
Practice address
560 Riverside Dr Ste A204
Salisbury, MD 21801-4704
Phone
(443) 358-6193
Fax
(443) 358-6197
NPI assigned
Jun 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R128087 MD Primary

Addresses

Primary practice location

560 Riverside Dr Ste A204
Salisbury, MD 21801-4704

Mailing address

PO Box 1978
Salisbury, MD 21802-1978
Phone (410) 749-1015

Other names 1

  • Ms. Jane Ngozi Nwabufo Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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

Enrollment IDStateProvider typePAC IDDetails
I20191022003031 MD Practitioner - Nurse Practitioner 2668704768 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6830 Hospital Dr
Suite 110
Rosedale, MD 21237-4375
Phone (443) 884-5530

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baltimore County Mental Health Associates LLC CurrentSince Nov 4, 2020 Accepting new patients

Locations

1232 Race Rd
Ste 401
Rosedale, MD 21237
Phone (410) 574-9090

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1285296384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1978",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218021978",
            "telephone_number": "410-749-1015",
            "fax_number": "410-749-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 RIVERSIDE DR STE A204",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218014704",
            "telephone_number": "443-358-6193",
            "fax_number": "443-358-6197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IWEBO",
        "first_name": "JANE",
        "middle_name": "NGOZI",
        "name_prefix": "Ms.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-28",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R128087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JANE",
            "last_name": "NWABUFO",
            "middle_name": "NGOZI",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Salisbury, MD

Sources for this page

Verify at the official NPI Registry.