NPIMap

Individual provider Active NPI

Raphael N Ngengwe, MD

  • Clinical Cardiac Electrophysiology Physician
  • Jonesboro, AR
National Provider Identifier
1699865857
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
E9433 Issued in AR
Practice address
201 E Oak Ave
Jonesboro, AR 72401-4163
Phone
(870) 935-6729
Fax
(870) 268-4478
NPI assigned
Oct 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X E9433 AR Primary
Cardiovascular Disease Physician 207RC0000X 14665 SD

Addresses

Primary practice location

201 E Oak Ave
Jonesboro, AR 72401-4163

Mailing address

201 E Oak Ave
Jonesboro, AR 72401-4163
Phone (870) 935-6729

Other identifiers 2

IdentifierTypeStateIssuer
1699865857MedicaidAR
E9433OtherARSTATE MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MO, SD3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20061030000008 OH Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 0840297198 Reassigns benefits to 1 organization
I20100923001119 MO Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0840297198 Reassigns benefits to 2 organizations
I20231213003682 SD Practitioner - Cardiovascular Disease (Cardiology) 0840297198 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Missouri, Kansas City, School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical CenterGroup PAC ID 8325950215, 847 clinicians

Practice addresses (Care Compare)

1301 W 18TH St
Sioux Falls, SD 57105-0401
Phone (605) 312-2200

1305 W 18TH St
Sioux Falls, SD 57105-0401
Phone (605) 312-7300

371 S Broadview St
Cape Girardeau, MO 63703-5761
Phone (573) 331-6710

4405 E 26TH St
Sioux Falls, SD 57103-4187
Phone (605) 332-2883

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.92 of 100Reported as group
Quality
61.64
Improvement activities
40
Cost
72.07

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
78.77
Promoting interoperability
100
Improvement activities
40
Cost
70.49

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair126

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E9433ARMDClinical Cardiac Electrophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Missouri Hospital Physicians, LLC Cardiovascular Disease CurrentSince Dec 18, 2023 Accepting new patients
Southeast Hospital CurrentSince Aug 24, 2024 Accepting new patients
Sanford Medical Center CurrentSince Oct 2, 2023 Accepting new patients
Mercy Health Physicians North Specialty Care LLC CurrentSince Dec 1, 2022 Accepting new patients
Mercy Health Physicians North Specialty Care LLC Cardiovascular Disease CurrentSince Dec 1, 2022 Accepting new patients
Southeast Hospital CurrentSince Aug 24, 2024 Accepting new patients
Sanford Medical Center CurrentSince Oct 2, 2023 Accepting new patients
Lakewood Hospital Association Past Accepting new patients
Lakewood Hospital Association Past Accepting new patients

Locations

371 S Broadview St
Cape Girardeau, MO 63703
Phone (573) 331-6710

1701 Lacey St
Cpe Girardeau, MO 63701
Phone (573) 334-4822

2200 Jefferson Ave
Fl 5
Toledo, OH 43604
Phone (419) 251-9826

3900 Sunforest Ct
Ste 240
Toledo, OH 43623
Phone (419) 472-3126

2213 Cherry St
Ste 200
Toledo, OH 43608
Phone (419) 251-4283

4405 E 26th St
Sioux Falls, SD 57103
Phone (605) 328-9000

1305 W 18th St
Sioux Falls, SD 57105
Phone (605) 312-7300

Organizations & group practices 9

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1699865857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E OAK AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014163",
            "telephone_number": "870-935-6729",
            "fax_number": "870-935-6729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E OAK AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014163",
            "telephone_number": "870-935-6729",
            "fax_number": "870-268-4478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGENGWE",
        "first_name": "RAPHAEL",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "AR",
            "license": "E9433",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "SD",
            "license": "14665",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699865857",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "E9433",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.