Etienne T Ngoumgna, PA-C MHS MSC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

C0002500 Issued in MD

Practice address

821 N Eutaw St
Suite 103
Baltimore, MD 21201-4648

Phone

(410) 225-8760

NPI assigned

Jan 8, 2009

Last updated

Jul 8, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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 1

Specialty

Physician Assistant

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Agnes Healthcare IncGroup PAC ID 9830092733, 265 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Agnes Hospital Hospital, Baltimore, MD, CCN 210011

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• St Agnes Healthcare Inc

  dba Integrated Specialists Group

  • Internal Medicine Physician
  • Baltimore, MD
  • NPI 1144250176

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• St Agnes Healthcare Inc

  • Diagnostic Radiology Physician
  • Baltimore, MD
  • NPI 1780615922
  NPD
• Anthony & Banerjee MD PA

  • Infectious Disease Physician
  • Baltimore, MD
  • NPI 1083690143
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St. Agnes Healthcare, Inc.

  dba St.Agnes Hospital

  • General Acute Care Hospital
  • Baltimore, MD
  • NPI 1245274901
  Care Compare affiliation

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

{
    "created_epoch": "1231372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278547200000",
    "number": "1487891776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 N EUTAW ST",
            "address_2": "SUITE 103",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212014648",
            "telephone_number": "410-225-8760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 N EUTAW ST",
            "address_2": "SUITE 103",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212014648",
            "telephone_number": "410-225-8760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGOUMGNA",
        "first_name": "ETIENNE",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "credential": "PA-C  MHS MSC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-08",
        "last_updated": "2010-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0002500",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0002500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sabrina Ngo, M.D.
• Blessing Chioma Ngobiri
• Enuolare Ngofa
• Patience Ngoh
• Sabrina Monique Ngong, M.D.
• Jazzmon Lee Nguedjo, O.D.
• Sweetteen Ngugi
• Junior Nguimi
• Jessica VI Nguyen-Binder, M.D.
• Alyssa Nicole Nguyen

• Medical Physician Assistant in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.