Individual provider Active NPI

Ifeoma Umelo

  • Adult Mental Health Clinic/Center
  • Raleigh, NC
National Provider Identifier
1790322725
Registry record updated Dec 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
MHL-092-973 Issued in NC
Practice address
1921 Waters Dr
Raleigh, NC 27610-4836
Phone
(919) 539-9223
NPI assigned
Dec 10, 2019
Last updated
Dec 10, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X MHL-092-973 NC Primary

Addresses

Primary practice location

1921 Waters Dr
Raleigh, NC 27610-4836

Mailing address

2204 Havering PL
Raleigh, NC 27604-0801
Phone (919) 539-9223

Other identifiers 1

IdentifierTypeStateIssuer
C201919301765MedicaidNC

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

State licenses

LicenseStateTypeSpecialty
MHL-092-973NCMDAdult Mental Health Clinic/Center

Practice roles

OrganizationSpecialtyStatusNew patients
Twinkle-Star Home Services LLC CurrentSince Dec 15, 2019 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1575936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1790322725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 HAVERING PL",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276040801",
            "telephone_number": "919-539-9223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 WATERS DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276104836",
            "telephone_number": "919-539-9223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UMELO",
        "first_name": "IFEOMA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-10",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NC",
            "license": "MHL-092-973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "C201919301765",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.