Active NPI
Shankar Ezom
- Case Manager/Care Coordinator
- Fargo, ND
National Provider Identifier
1669191979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 7220 28TH St S
Fargo, ND 58104-4589 - Phone
- (701) 630-9912
- NPI assigned
- Aug 22, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary | ||
| Peer Specialist | 175T00000X |
Addresses
Primary practice location
7220 28TH St S
Fargo, ND 58104-4589
Mailing address
7220 28TH St S
Fargo, ND 58104-4589
Phone (701) 630-9912
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673827200000",
"number": "1669191979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7220 28TH ST S",
"city": "FARGO",
"state": "ND",
"postal_code": "581044589",
"telephone_number": "701-630-9912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7220 28TH ST S",
"city": "FARGO",
"state": "ND",
"postal_code": "581044589",
"telephone_number": "701-630-9912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZOM",
"first_name": "SHANKAR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-22",
"last_updated": "2023-01-16",
"certification_date": "2023-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.