Isabella A Ahanogbe, M.D.
Individual provider Active NPI Family Medicine Physician · Upper Marlboro, MD
NPI 1821381849 · NPPES record last updated Jun 25, 2021
Key facts
- NPI
- 1821381849
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 042004 (IA)
- Practice address
- 1221 Mercantile LN
Upper Marlboro, MD 20774-5374 - Phone
- (301) 761-8155
- NPI assigned
- May 24, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 18
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kaiser Foundation Health Plan of the Mid Atlantic States, Inc
Practice addresses (Care Compare)
1221 Mercantile LN
Largo, MD 20774-5374
Phone (301) 618-5700
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190509001523 | DC | Practitioner - Emergency Medicine | 6002036035 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042004 | IA | MD | Family Medicine Physician |
| MT199390 | PA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Family Medicine | Current | Accepting new patients |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current |
Accepting new patients |
Locations
2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853
1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MT199390 | PA | |
| Family Medicine Physician | 207Q00000X | 042004 | IA | Yes |
Addresses
Primary practice location
1221 Mercantile LN
Upper Marlboro, MD 20774-5374
Mailing address
1221 Mercantile LN
Upper Marlboro, MD 20774-5374
Phone (301) 618-5500
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways | Health Information Exchange (HIE) | |
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways | Health Information Exchange (HIE) |
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- Afuah Agyapong
- Nabeela Kalim Ahmed
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- Ernest N Ajang
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All providers in Upper Marlboro, MD · Family Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.