Individual provider Active NPI

Agerie Ejigu, CRNP-PMH

  • Psychiatric/Mental Health Nurse Practitioner
  • Bethesda, MD
National Provider Identifier
1871044784
Registry record updated Oct 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R168759 Issued in MD
Practice address
6040 Southport Dr
Bethesda, MD 20814-1848
Phone
(301) 493-4200
NPI assigned
Oct 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2016

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 R168759 MD Primary

Addresses

Primary practice location

6040 Southport Dr
Bethesda, MD 20814-1848

Mailing address

6040 Southport Dr
Bethesda, MD 20814-1848
Phone (301) 493-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161216000075 DC Practitioner - Nurse Practitioner 7416237011 Reassigns benefits to 3 organizations
I20170202002286 MD Practitioner - Nurse Practitioner 7416237011 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R168759MDMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Della Behavioral Health Services CurrentSince Nov 8, 2018 Accepting new patients
Cornerstone Montgomery, Inc. CurrentSince Nov 8, 2016 Accepting new patients
Axis Healthcare Group CurrentSince Feb 5, 2021 Accepting new patients
Jewish Community Services, Inc CurrentSince Sep 6, 2023 Accepting new patients
Cornerstone Montgomery, Inc. CurrentSince Nov 8, 2016 Accepting new patients
Green Ridge Behavioral Health, LLC PastSince Aug 8, 2017 Accepting new patients

Locations

5028 Wisconsin Ave NW
Ste 400
Washington, DC 20016
Phone (202) 237-2700

1150 Varnum St NE
Washington, DC 20017
Phone (202) 269-7000

1310 Southern Ave SE
Washington, DC 20032
Phone (202) 574-6000

5750 Park Heights Ave
Baltimore, MD 21215
Phone (410) 466-9200

6040 Southport Dr
Bethesda, MD 20814
Phone 3014934200228

5755 Cedar Ln
Columbia, MD 21044
Phone (410) 381-7171

9841 Broken Land Pkwy
Ste 314
Columbia, MD 21046
Phone (410) 929-7225

7067 Columbia Gateway Dr
Ste 180
Columbia, MD 21046
Phone (410) 925-7225

25500 Point Lookout Rd
Leonardtown, MD 20650
Phone (301) 475-6106

2 Taft Ct
Ste 200
Rockville, MD 20850
Phone (301) 715-3673

Organizations & group practices 6

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": "1476662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476662400000",
    "number": "1871044784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6040 SOUTHPORT DR",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208141848",
            "telephone_number": "301-493-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6040 SOUTHPORT DR",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208141848",
            "telephone_number": "301-493-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EJIGU",
        "first_name": "AGERIE",
        "credential": "CRNP-PMH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R168759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethesda, MD

Sources for this page

Verify at the official NPI Registry.