Individual provider Active NPI

Stella Ijeoma Agunenye

  • Psychiatric/Mental Health Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1417523432
Registry record updated Oct 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R182859 Issued in MD
Practice address
1828 Hanford Rd
Baltimore, MD 21237-1744
Phone
(443) 559-1875
NPI assigned
Jun 1, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2022

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 R182859 MD Primary

Addresses

Primary practice location

1828 Hanford Rd
Baltimore, MD 21237-1744

Mailing address

1828 Hanford Rd
Baltimore, MD 21237-1744
Phone (443) 559-1875

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230322001613 DC Practitioner - Nurse Practitioner 3476926122
I20231011002106 MD Practitioner - Nurse Practitioner 3476926122 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6018 Harford Rd
Baltimore, MD 21214-1327
Phone (410) 777-5664

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R182859MDMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Angels Healthcare Services LLC CurrentSince Jun 6, 2021 Accepting new patients
Atosk Healthcare Services, Inc CurrentSince Sep 4, 2020 Accepting new patients
Atosk Healthcare Services, Inc CurrentSince Jun 9, 2024 Accepting new patients
Stel Better Healthcare Services Inc CurrentSince Jul 7, 2023 Accepting new patients
Mercymary Behavioral Health LLC CurrentSince Nov 1, 2022 Accepting new patients

Locations

6018 Harford Rd
Baltimore, MD 21214
Phone (443) 570-2706

9801 Greenbelt Rd
Ste 106
Lanham, MD 20706
Phone (443) 559-1875

1055 Taylor Ave
Ste 207
Towson, MD 21286
Phone (410) 321-6826

1055 Taylor Ave
Ste 100
Towson, MD 21286
Phone (410) 321-6826

Organizations & group practices 5

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": "1622505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1417523432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1828 HANFORD RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212371744",
            "telephone_number": "443-559-1875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1828 HANFORD RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212371744",
            "telephone_number": "443-559-1875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGUNENYE",
        "first_name": "STELLA",
        "middle_name": "IJEOMA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-01",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R182859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.