Odilichi Ezenwanne, M.D.

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

License

67275 Issued in WI

Practice address

1820 Peabody St
Tunica, MS 38676-9441

Phone

(662) 363-3656

NPI assigned

Jul 27, 2010

Last updated

Feb 18, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family PracticeAlso: General Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aaron E Henry Community HealthGroup PAC ID 1153230560, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: odilichi.ezenwanne@aehchc.eclinicaldirectplus.com

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.

• Aaron E Henry Community Health

  • Federally Qualified Health Center (FQHC)
  • Batesville, MS
  • NPI 1003814104
  Medicare reassignment Care Compare group NPD
• Aaron E. Henry Community Health Services Center, Inc

  • Pediatrics Physician
  • Clarksdale, MS
  • NPI 1134868672
  NPD
• Aaron E Henry Community Health

  dba Aaron E Henry Mobile Medical Unit #3

  • Federally Qualified Health Center (FQHC)
  • Clarksdale, MS
  • NPI 1063756716
  NPD (past)

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

{
    "created_epoch": "1280188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581984000000",
    "number": "1841504206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 PEABODY ST",
            "city": "TUNICA",
            "state": "MS",
            "postal_code": "386769441",
            "telephone_number": "662-363-3656",
            "fax_number": "662-363-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 PEABODY ST",
            "city": "TUNICA",
            "state": "MS",
            "postal_code": "386769441",
            "telephone_number": "662-363-3656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZENWANNE",
        "first_name": "ODILICHI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-27",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "MS",
            "license": "27125",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "WI",
            "license": "67275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yaminoh Childress-Dunbar, M.S.
• Covenant Adult Day Care of Tunica
• Delta House Calls
• Erin Douget, MS, RD, LDN
• Epic Medical Supplies, Inc.
• Angela Goff Foshee, RPH
• Freds Stores of Tennessee Inc (Freds Pharmacy #3604)
• Crystal Gholston
• Ayanna Hawkins
• Hope Hospice & Pallative Care LLC

• Public Health & General Preventive Medicine Physician in Tunica, MS
• Providers in Tunica, MS by specialty
• Public Health & General Preventive Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2020; 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.