KENNETH EZENWA RN
NPI 1003379959
Nurse Practitioner - Psychiatric/Mental Health in Canyon Country, CA
About Kenneth Ezenwa Rn NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KENNETH EZENWA RN (NPI 1003379959) is an individual psychiatric/mental health provider in Canyon Country, California, licensed in California (95080178) and active in the NPI registry since April 2019. He is enrolled in Medicare PECOS and is a graduate of Other (2020).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Kenneth Ezenwa Rn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Kenneth Ezenwa reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Lancaster, CA 93534
- Reassigned Medicare billing, California enrollment
- 194 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 3
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 91387 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
CANYON COUNTRY, CA 91387
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kenneth Ezenwa's NPI number?
The NPI number for Kenneth Ezenwa is 1003379959. It was assigned to this individual provider in the NPPES registry on April 8, 2019.
Where is Kenneth Ezenwa located?
Kenneth Ezenwa practices at 17467 Honey Maple St, Canyon Country, CA 91387. The listed phone number is (661) 212-5273.
What is Kenneth Ezenwa's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Kenneth Ezenwa enrolled in Medicare?
Yes. Kenneth Ezenwa is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Kenneth Ezenwa's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Ezenwa reassigns Medicare benefits to Inland Psychiatric Medical Group, Inc. (Lancaster, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kenneth Ezenwa's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kenneth Ezenwa was last updated on February 8, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kenneth Ezenwa, RN · NPI 1003379959
Psychiatric/Mental Health physician in Canyon Country, California. Individual provider, active in the CMS NPPES registry since April 8, 2019.
## Identity
- **NPI:** 1003379959 (Entity type: Individual)
- **Enumerated:** April 8, 2019
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 95080178 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 17467 HONEY MAPLE ST, Canyon Country, CA 91387-6870
- **Phone:** (661) 212-5273
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Inland Psychiatric Medical Group, Inc. (NPI 1316533417, Lancaster, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** February 8, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1003379959) · Data from the CMS NPPES public registry.