Active NPI
Gibson Iyeke Erhunmwunse, NP
- Nurse Practitioner
- Arlington, VA
National Provider Identifier
1710080205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 0017138050
- Practice address
- 550 S Carlin Springs Rd
Arlington, VA 22204 - Phone
- (703) 379-7200
- Fax
- (703) 578-5524
- NPI assigned
- Sep 7, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 0017138050 | VA | Primary |
Addresses
Primary practice location
550 S Carlin Springs Rd
Arlington, VA 22204
Mailing address
2812 Cornflower LN
Waldorf, MD 20603
Phone (301) 885-1587
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00260751 | Other | VA | RR MEDICARE |
| 010239796 | Medicaid | VA |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0017138050 | VA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pavilion Medical Home Care & Staffing, LLC | Past | Accepting new patients | |
| Pavilion Med Transportation, LLC | Past | Accepting new patients | |
| Pavilion Medical Home Care & Staffing LLC | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Non-emergency Medical Transport (VAN)
- Annandale, VA
- NPI 1396592101
-
- Home Health Agency
- Annandale, VA
- NPI 1376620120
-
- Home Health Agency
- North Andover, MA
- NPI 1184085045
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630540800000",
"number": "1710080205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2812 CORNFLOWER LN",
"city": "WALDORF",
"state": "MD",
"postal_code": "20603",
"telephone_number": "301-885-1587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 S CARLIN SPRINGS RD",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "22204",
"telephone_number": "703-379-7200",
"fax_number": "703-578-5524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERHUNMWUNSE",
"first_name": "GIBSON",
"middle_name": "IYEKE",
"name_prefix": "Mr.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2021-09-02",
"certification_date": "2021-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "VA",
"license": "0017138050",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00260751",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "010239796",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Arlington, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.