Individual provider Active NPI

Jerome Nchamukong, MD

  • Family Medicine Physician
  • Wilmington, DE
National Provider Identifier
1740786342
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C1-0024246 Issued in DE
Practice address
701 N Clayton St
Wilmington, DE 19805-3165
Phone
(302) 575-8040
NPI assigned
Apr 3, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C7-0006877 DE
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X C1-0024246 DE Primary

Addresses

Primary practice location

701 N Clayton St
Wilmington, DE 19805-3165

Mailing address

701 N Clayton St
Wilmington, DE 19805-3165

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE, MD2 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

Enrollment IDStateProvider typePAC IDDetails
I20210603002989 DE Practitioner - Family PracticePractitioner - Internal Medicine 1759637499 Reassigns benefits to 1 organization
I20211214002849 MD Practitioner - Family Practice 1759637499 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Union Hospital of Cecil CountyGroup PAC ID 6901719822, 281 clinicians
Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

106 Bow St
Elkton, MD 21921-5544
Phone (410) 398-4000

4755 Ogletown Stanton Rd
Newark, DE 19718-2200
Phone (302) 623-0188

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Union Hospital of Cecil County CurrentSince Sep 9, 2021 Accepting new patients
Union Hospital of Cecil County Family Medicine CurrentSince Sep 9, 2021 Accepting new patients
Christiana Care Health Services, Inc. Past Accepting new patients

Locations

4755 Ogletown Stanton Rd
Ste 5A43
Newark, DE 19718
Phone (302) 623-0188

4755 Ogletown Stanton Rd
Newark, DE 19718
Phone (302) 733-1700

106 Bow St
Elkton, MD 21921
Phone (410) 298-2000

Organizations & group practices 4

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 1

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": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1740786342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 N CLAYTON ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198053165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N CLAYTON ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198053165",
            "telephone_number": "302-575-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NCHAMUKONG",
        "first_name": "JEROME",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "DE",
            "license": "C7-0006877",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "DE",
            "license": "C1-0024246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

Verify at the official NPI Registry.