NPIMap

Individual provider Active NPI

Elias N Ezike, MD

  • Pediatrics Physician
  • Beaumont, TX
National Provider Identifier
1811902307
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
M4774 Issued in TX
Practice address
87 Interstate 10 N Ste 221
Beaumont, TX 77707-2562
Phone
(409) 838-9944
Fax
(409) 838-9086
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 052430 GA
Pediatric Infectious Diseases Physician 2080P0208X M4774 TX
Pediatrics Physician 208000000X 4301076996 MI
Pediatrics Physician 208000000X M4774 TX Primary

Addresses

Primary practice location

87 Interstate 10 N Ste 221
Beaumont, TX 77707-2562

Mailing address

87 Interstate 10 N Ste 221
Beaumont, TX 77707-2562
Phone (409) 838-9944

Other practice location 1

3127 College St
Beaumont, TX 77701-4609
Phone (409) 899-1433

Other identifiers 2

IdentifierTypeStateIssuer
193069506MedicaidTX
990624171AMedicaidGA

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
052430GAMDPediatrics Physician
4301076996MIMDPediatrics Physician
M4774TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Inc Pediatrics Past Accepting new patients
Elias Ezike, MD, P.a Pediatric Infectious Diseases Past Accepting new patients
Christus Health Southeast Texas Past Accepting new patients
Beaumont Nephrology Associates Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1811902307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87 INTERSTATE 10 N STE 221",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777072562",
            "telephone_number": "409-838-9944",
            "fax_number": "409-838-9086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 INTERSTATE 10 N STE 221",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777072562",
            "telephone_number": "409-838-9944",
            "fax_number": "409-838-9086"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3127 College St",
            "address_purpose": "LOCATION",
            "city": "Beaumont",
            "state": "TX",
            "postal_code": "777014609",
            "country_code": "US",
            "telephone_number": "409-899-1433",
            "fax_number": "409-981-9089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EZIKE",
        "first_name": "ELIAS",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "052430",
            "primary": false
        },
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "TX",
            "license": "M4774",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301076996",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "M4774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "193069506",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "990624171A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.