NPIMap

Individual provider Active NPI

Alfred Ezekwesili

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baltimore, MD
National Provider Identifier
1902478290
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
200709996 Issued in MD
Practice address
1 E Chase St Ste 1125
Baltimore, MD 21202-2565
Phone
(410) 298-3431
NPI assigned
Jul 15, 2021
Last updated
Jul 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 200709996 MD Primary

Addresses

Primary practice location

1 E Chase St Ste 1125
Baltimore, MD 21202-2565

Mailing address

1502 Woodlawn Dr Ste 103
Baltimore, MD 21207-4022
Phone (410) 298-3431

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL ijeaku@trulifehealthservices.com Direct
Direct Messaging Address ijeaku@trulifehealthservices.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
200709996MDMDMental Health Clinic/Center (Including Community Mental Health Center)

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, 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": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1902478290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 WOODLAWN DR STE 103",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212074022",
            "telephone_number": "410-298-3431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 E CHASE ST STE 1125",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022565",
            "telephone_number": "410-298-3431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZEKWESILI",
        "first_name": "ALFRED",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MD",
            "license": "200709996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ijeaku@trulifehealthservices.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "1 E Chase St Ste 1125",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212022565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ijeaku@trulifehealthservices.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "1 E Chase St Ste 1125",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212022565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.