Josepha Immanuel, M.D

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

R0252 Issued in TX

Practice address

5602 Lyons Ave
Houston, TX 77020

Phone

(832) 548-5000

NPI assigned

Apr 11, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Josepha-Pearl Aigbodesi Iluonakhamhe Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI, IN2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jimmanuel56724@edirect.crh.org

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.

• Ascension NE Wisconsin, Inc

  • General Acute Care Hospital
  • Appleton, WI
  • NPI 1407803638
  Medicare reassignment NPD
• Columbia St. Mary'S Hospital Milwaukee, Inc

  • Multi-Specialty Clinic/Center
  • Milwaukee, WI
  • NPI 1023064482
  Medicare reassignment NPD
• Columbus Regional Health Physicians, LLC

  • Internal Medicine Physician
  • Columbus, IN
  • NPI 1336510098
  Medicare reassignment NPD
• The Howard Young Medical Center, Inc.

  • General Acute Care Hospital
  • Woodruff, WI
  • NPI 1184673352
  Medicare reassignment NPD
• Ascension NE Wisconsin, Inc

  • General Acute Care Hospital
  • Oshkosh, WI
  • NPI 1912527193
  NPD
• Butte Des Morts Pathology, S.C.

  • Anatomic Pathology & Clinical Pathology Physician
  • Appleton, WI
  • NPI 1205886918
  NPD
• Columbia St. Mary'S Hospital Milwaukee Inc

  • Psychiatric Hospital Unit
  • Mequon, WI
  • NPI 1417600909
  NPD
• Columbus Regional Health Physicians, LLC

  • Family Medicine Physician
  • Columbus, IN
  • NPI 1740650225
  NPD
• The Howard Young Medical Center, Inc.

  • General Acute Care Hospital
  • Woodruff, WI
  • NPI 1134183171
  NPD
• Sacred Heart Rehabilitation Institute, Inc.

  • Rehabilitation Hospital
  • Mequon, WI
  • NPI 1508920356
  NPD (past)

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

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1578853586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66308",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772666308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5602 LYONS AVE",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77020",
            "telephone_number": "832-548-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2400 17th St",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "IN",
            "postal_code": "472015351",
            "country_code": "US",
            "telephone_number": "812-376-5016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IMMANUEL",
        "first_name": "JOSEPHA",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-11",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "R0252",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IN",
            "license": "01094972A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jimmanuel56724@edirect.crh.org",
            "affiliation": "N",
            "endpointDescription": "Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct address",
            "address_1": "2400 17th St",
            "city": "Columbus",
            "state": "IN",
            "country_code": "US",
            "postal_code": "472015351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JOSEPHA-PEARL",
            "last_name": "ILUONAKHAMHE",
            "middle_name": "AIGBODESI",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Immaculate Living Care, LLC
• Immaculate Nursing LLC
• Immaculate Transportation LLC
• Nang Immanivong
• Immanuel Dental Center
• Kevin Emitseilu Immanuel, M.D
• Oluchi Ibekwe Immanuel, MD
• Immediate Care Centers LLC
• Immediate Care Group, Inc
• Immediate Medical Equipment Providers

• Child & Adolescent Psychiatry Physician in Houston, TX
• Providers in Houston, TX by specialty
• Child & Adolescent Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.