Individual provider Active NPI

Angelica Ehioba, MD

  • Family Medicine Physician
  • Mitchellville, MD
National Provider Identifier
1356920300
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0101160 Issued in MD
Practice address
12158 Central Ave
Mitchellville, MD 20721-1932
Phone
(301) 430-2700
Fax
(301) 779-9001
NPI assigned
Apr 6, 2021
Last updated
Sep 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X D0101160 MD Primary

Addresses

Primary practice location

12158 Central Ave
Mitchellville, MD 20721-1932

Mailing address

12158 Central Ave
Mitchellville, MD 20721-1932
Phone (301) 430-2700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240912001290 MD Practitioner - Family Practice 5991245391 Reassigns benefits to 1 organization
I20241220003881 DC Practitioner - Family Practice 5991245391 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

1145 19TH St NW
311 MMG at 19TH Street NW
Washington, DC 20036-3735
Phone (202) 429-2401

12158 Central Ave
Mitchellville, MD 20721-1932
Phone (301) 430-2750

3007 Tilden St NE
Suite 5N
Washington, DC 20008-3030

3007 Tilden St NW
Washington, DC 20008-3030

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Jul 30, 2024 Accepting new patients
Medstar Medical Group II LLC CurrentSince Oct 18, 2024 Accepting new patients
Medstar Medical Group II LLC Past Accepting new patients

Locations

110 Irving St NW
Washington, DC 20010
Phone (202) 877-2000

1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401

3007 Tilden St NW
Ste 5N
Washington, DC 20008

29955 Three Notch Rd
Ste 100
Charlotte Hall, MD 20622
Phone (301) 290-5300

1406 Crain Hwy S
Ste 106
Glen Burnie, MD 21061
Phone (410) 768-6440

12158 Central Ave
Mitchellville, MD 20721
Phone (301) 390-3076

Interoperability endpoints

  • Direct secure messaging: angelica.ehiobamd.p2@direct.msmg.nextgenshare.com

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1617667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1356920300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12158 CENTRAL AVE",
            "city": "MITCHELLVILLE",
            "state": "MD",
            "postal_code": "207211932",
            "telephone_number": "301-430-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12158 CENTRAL AVE",
            "city": "MITCHELLVILLE",
            "state": "MD",
            "postal_code": "207211932",
            "telephone_number": "301-430-2700",
            "fax_number": "301-779-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHIOBA",
        "first_name": "ANGELICA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-06",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0101160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mitchellville, MD

Sources for this page

Verify at the official NPI Registry.