Individual provider Active NPI

Ijeoma Ajufo, MD

  • Psychiatry Physician
  • San Antonio, TX
National Provider Identifier
1902216427
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
R5349 Issued in TX
Practice address
17720 Corporate Woods Dr
San Antonio, TX 78259
Phone
(210) 491-9400
Fax
(210) 491-3550
NPI assigned
May 6, 2014
Last updated
Jun 21, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X R5349 TX Primary

Addresses

Primary practice location

17720 Corporate Woods Dr
San Antonio, TX 78259

Mailing address

PO Box 3046
Malvern, PA 19355-0746
Phone (210) 491-9400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20180613002163 TX Practitioner - Psychiatry 7517265820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

12650 Nacogdoches Rd
San Antonio, TX 78217-2118
Phone (210) 475-3048

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R5349TXMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northridge Behavioral Health PLLC Psychiatry CurrentSince Sep 22, 2020 Accepting new patients

Locations

12650 Nacogdoches Rd
San Antonio, TX 78217
Phone (210) 656-4363

2829 Babcock Rd
Ste 126
San Antonio, TX 78229
Phone (210) 706-0880

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1399334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529539200000",
    "number": "1902216427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3046",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193550746",
            "telephone_number": "210-491-9400",
            "fax_number": "210-491-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17720 CORPORATE WOODS DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78259",
            "telephone_number": "210-491-9400",
            "fax_number": "210-491-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJUFO",
        "first_name": "IJEOMA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-06",
        "last_updated": "2018-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "R5349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.