Angel Vivian Mbome, CRNP, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R217061 Issued in MD

Practice address

801 Wayne Ave Ste G100
Silver Spring, MD 20910-4493

Phone

(301) 615-8752

Fax

(240) 503-3254

NPI assigned

Jun 22, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DC, MD2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Psychogeriatric Services LLCGroup PAC ID 6002719226, 122 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• El Roi Psychiatry and Wellness

  • Psychiatric/Mental Health Nurse Practitioner
  • Bryans Road, MD
  • NPI 1801783170

  Single Specialty

  Medicare reassignment NPD Authorized official
• Psychogeriatric Services LLC

  • Psychiatry Physician
  • Columbia, MD
  • NPI 1588689483

  DC, Single Specialty

  Medicare reassignment Care Compare group NPD
• Ultimate Goal Home Care Agency Inc

  • Home Health Agency
  • College Park, MD
  • NPI 1437441896
  NPD (past)

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

{
    "created_epoch": "1340323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1811250905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 WAYNE AVE STE G100",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209104493",
            "telephone_number": "301-615-8752",
            "fax_number": "240-503-3254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 WAYNE AVE STE G100",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209104493",
            "telephone_number": "301-615-8752",
            "fax_number": "240-503-3254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBOME",
        "first_name": "ANGEL",
        "middle_name": "VIVIAN",
        "credential": "CRNP, PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-22",
        "last_updated": "2023-11-27",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R217061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ambome@innovativepsychllc.com",
            "affiliation": "Y",
            "endpointDescription": "work e-mail",
            "affiliationName": "Innovative Psychiatric Associates LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "801 Wayne Ave Ste G100",
            "city": "Silver Spring",
            "state": "MD",
            "country_code": "US",
            "postal_code": "209104493",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chantal Mbiandji
• Yoland Mbinze
• Joan Dzebe Mbiywong Epse Kanigha, HHA
• Eseme Mboh Fritz
• Atud Briyan Mboh
• Erica Mbong
• Rosine Kelly Kouebou Mboukem
• Thomas Mboum
• Mireille Mboumbou
• Arrey Mbu Ayang

• Psychiatric/Mental Health Nurse Practitioner in Silver Spring, MD
• Providers in Silver Spring, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.