NPIMap

Organization Active NPI

Amazing Grace Medical Center LLC

  • Family Medicine Physician
  • Phillipsburg, NJ
National Provider Identifier
1801420948
Registry record updated Feb 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AMAZING GRACE MEDICAL CENTER LLC
Practice address
445 Marshall St
Phillipsburg, NJ 08865-2695
Phone
(609) 582-0899
Fax
(833) 957-0121
NPI assigned
Feb 27, 2020
Last updated
Feb 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2020

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

Authorized official

Name
Ebere Ezeanya, MDNPI 1053547919
Title
Owner
Phone
(973) 704-5644

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

445 Marshall St
Phillipsburg, NJ 08865-2695

Mailing address

4995 Derby LN
Bethlehem, PA 18020-9418
Phone (973) 704-5644

Other practice location 1

641 North 13TH Street
Suite E-101
Easton, PA 18042
Phone (609) 582-0899

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address amazinggrace@xxx.direct.charmhealth.com Direct
Direct Messaging Address amazinggrace@xxx.direct.charmhealth.com Direct

National Provider Directory

National Provider Directory

Locations

37 Main St
Ste 5
Clinton, NJ 08809
Phone (609) 582-0899

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582761600000",
    "number": "1801420948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4995 DERBY LN",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180209418",
            "telephone_number": "973-704-5644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 MARSHALL ST",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088652695",
            "telephone_number": "609-582-0899",
            "fax_number": "833-957-0121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "641 NORTH 13TH STREET",
            "address_2": "SUITE E-101",
            "address_purpose": "LOCATION",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "18042",
            "country_code": "US",
            "telephone_number": "609-582-0899",
            "fax_number": "833-957-0121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AMAZING GRACE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-27",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A",
        "authorized_official_last_name": "EZEANYA",
        "authorized_official_first_name": "EBERE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-704-5644",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amazinggrace@xxx.direct.charmhealth.com",
            "affiliation": "N",
            "endpointDescription": "amazinggrace@xxx.direct.charmhealth.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "445 Marshall St",
            "city": "Phillipsburg",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "088652695",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amazinggrace@xxx.direct.charmhealth.com",
            "affiliation": "N",
            "endpointDescription": "amazinggrace@xxx.direct.charmhealth.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "641 NORTH 13TH STREET",
            "address_2": "SUITE E-101",
            "city": "EASTON",
            "state": "PA",
            "country_code": "US",
            "postal_code": "18042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Phillipsburg, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; 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.