Individual provider Active NPI

Chidozie Ephrem Ibe, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Oakland, CA
National Provider Identifier
1801493887
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95014912 Issued in CA
Practice address
2620 26TH Ave
Oakland, CA 94601-1907
Phone
(510) 437-2363
NPI assigned
Oct 2, 2020
Last updated
Oct 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95014912 CA Primary

Addresses

Primary practice location

2620 26TH Ave
Oakland, CA 94601-1907

Mailing address

1172 Roxanne Ave
Hayward, CA 94542-1051
Phone (408) 386-9403

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210525001929 CA Practitioner - Nurse Practitioner 5395144331 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95014912CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Telecare Corporation CurrentSince Feb 18, 2021 Accepting new patients
Telecare Corporation CurrentSince Feb 18, 2021 Accepting new patients
Telecare Corporation Current Accepting new patients

Locations

1080 Marina Village Pkwy
Ste 100
Alameda, CA 94501
Phone (510) 306-5660

280 17th St
Oakland, CA 94612
Phone (510) 238-5020

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, 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": "1601596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1801493887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1172 ROXANNE AVE",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945421051",
            "telephone_number": "408-386-9403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 26TH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946011907",
            "telephone_number": "510-437-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBE",
        "first_name": "CHIDOZIE",
        "middle_name": "EPHREM",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-02",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95014912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.