Individual provider Active NPI

Howard D. Ehrenfeld, M.D.

  • Neurology Physician
  • Las Vegas, NV
National Provider Identifier
1477647170
Registry record updated Aug 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
12114 Issued in NV
Practice address
4475 S Eastern Ave
Neurology Clinic
Las Vegas, NV 89119-7826
Phone
(702) 669-5944
Fax
(702) 737-5088
NPI assigned
Oct 3, 2006
Last updated
Aug 8, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 12114 NV Primary
Neurology Physician 2084N0400X 036524 GA

Addresses

Primary practice location

4475 S Eastern Ave
Neurology Clinic
Las Vegas, NV 89119-7826

Mailing address

PO Box 15645
4475 S Eastern Avenue
Las Vegas, NV 89114-5645
Phone (702) 669-5944

Other identifiers 2

IdentifierTypeStateIssuer
100511183MedicaidNV
1477647170MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20070214000057 NV Practitioner - Neurology 9830126275 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12114NVMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Medical Associates, Inc CurrentSince Jan 31, 2007 Accepting new patients
Optum Medical Group Rhodes P C CurrentSince Jun 4, 2019 Accepting new patients
Optum Medical Group II Rhodes P C CurrentSince Jun 4, 2019 Accepting new patients
Neurology and Headache Specialists of Atl, LLC Neurology Past Accepting new patients

Locations

2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330

420 N Nellis Blvd
Las Vegas, NV 89110
Phone (702) 339-5710

4475 S Eastern Ave
Las Vegas, NV 89119
Phone (702) 669-5811

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407456000000",
    "number": "1477647170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15645",
            "address_2": "4475 S EASTERN AVENUE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891145645",
            "telephone_number": "702-669-5944",
            "fax_number": "702-737-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4475 S EASTERN AVE",
            "address_2": "NEUROLOGY CLINIC",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891197826",
            "telephone_number": "702-669-5944",
            "fax_number": "702-737-5088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHRENFELD",
        "first_name": "HOWARD",
        "middle_name": "D.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2014-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NV",
            "license": "12114",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "036524",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100511183",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477647170",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.