Individual provider Active NPI

Nkemjika Ugonabo, M.D.

  • Student in an Organized Health Care Education/Training Program
  • New York, NY
National Provider Identifier
1447786991
Registry record updated Sep 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
550 1St Ave
New York, NY 10016
Phone
(212) 263-5506
NPI assigned
May 3, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

550 1St Ave
New York, NY 10016

Mailing address

564 1St Ave Apt 15B
New York, NY 10016-6487

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20230313001062 NY Practitioner - Dermatology 7416227210 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Michigan Medical School, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Union Square Laser DermatologyGroup PAC ID 6204000128, 4 clinicians

Practice addresses (Care Compare)

19 Union SQ W
FL 5
New York, NY 10003-3304
Phone (212) 366-5400

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions12
Skin biopsy13

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jan 13, 2023 Accepting new patients
Union Square Laser Dermatology CurrentSince Aug 1, 2023 Accepting new patients
Montefiore Medical Center CurrentSince Jan 13, 2023 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

19 Union Sq W
Fl 5
New York, NY 10003
Phone (212) 366-5400

550 1st Ave
New York, NY 10016
Phone (212) 263-3293

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: nugonabo683788@nychhc.direct-ci.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1447786991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "564 1ST AVE APT 15B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10016",
            "telephone_number": "212-263-5506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UGONABO",
        "first_name": "NKEMJIKA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-03",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.