NPIMap

Organization Active NPI

Aumbria Health and Aesthetics LLC

  • Internal Medicine Physician
  • Mesquite, NV
National Provider Identifier
1902298243
Registry record updated Mar 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
13300 Issued in NV
Legal business name
AUMBRIA HEALTH AND AESTHETICS LLC
Practice address
1301 Bertha Howe Ave
Ste# 2
Mesquite, NV 89027-7502
Phone
(702) 345-3312
Fax
(702) 345-3374
NPI assigned
Feb 24, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2016

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

Authorized official

Name
Dr. Gladys Ampong Kodjoe, M.D.
Title
Practice Owner
Phone
(702) 241-8721

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 13300 NV Primary

Addresses

Primary practice location

1301 Bertha Howe Ave
Ste# 2
Mesquite, NV 89027-7502

Mailing address

1301 Bertha Howe Ave
Ste# 2
Mesquite, NV 89027-7502
Phone (702) 345-3312

Other identifiers 1

IdentifierTypeStateIssuer
NV20151021732OtherNVNV SECRETARY OF STATE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150522001738 NV Part B Supplier - Clinic/Group Practice 9830419381 Receives reassigned benefits from 2 practitioners
Practice locations: Mesquite, NV

National Provider Directory

National Provider Directory

Locations

350 Falcon Ridge Pkwy
Ste 102
Mesquite, NV 89027
Phone (702) 345-3312

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1424736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458259200000",
    "number": "1902298243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 BERTHA HOWE AVE",
            "address_2": "STE# 2",
            "city": "MESQUITE",
            "state": "NV",
            "postal_code": "890277502",
            "telephone_number": "702-345-3312",
            "fax_number": "702-345-3374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 BERTHA HOWE AVE",
            "address_2": "STE# 2",
            "city": "MESQUITE",
            "state": "NV",
            "postal_code": "890277502",
            "telephone_number": "702-345-3312",
            "fax_number": "702-345-3374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUMBRIA HEALTH AND AESTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-24",
        "last_updated": "2016-03-18",
        "status": "A",
        "authorized_official_last_name": "KODJOE",
        "authorized_official_first_name": "GLADYS",
        "authorized_official_middle_name": "AMPONG",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "702-241-8721",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "13300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NV SECRETARY OF STATE",
            "identifier": "NV20151021732",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesquite, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.