Jaime Ingram

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

25062 S 190TH St
Queen Creek, AZ 85142-5668

Phone

(480) 329-0707

NPI assigned

Jan 16, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jaime Ingram Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Fortitude 611 LLC

  • Community/Behavioral Health Agency
  • Queen Creek, AZ
  • NPI 1003504390
  NPD Authorized official

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

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1306551122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25062 S 190TH ST",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851425668",
            "telephone_number": "480-329-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25062 S 190TH ST",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851425668",
            "telephone_number": "480-329-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "JAIME",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-16",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAIME",
            "last_name": "INGRAM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Stana Hunt, MAED
• Joshua Huynh, OD
• Okechukwu Oswald Ikedilo
• Imani Mental Health Services LLC
• In Motion Pediatric Physical Therapy LLC
• Tana D Ingram, MS, RDN
• Inner Bloom Professional Counseling Services LLC
• Integrated Medical Management, LLC
• Ironwood Dental Care PC
• Isaac a. Urling, DMD, PLLC

• Community Health Worker in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• Community Health Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.