IMANI MENTAL HEALTH AND WELLNESS LLC
NPI 1104415405
Nurse Practitioner - Psychiatric/Mental Health in Portland, OR
About Imani Mental Health And Wellness Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
IMANI MENTAL HEALTH AND WELLNESS LLC (NPI 1104415405) is a healthcare organization registered as a psychiatric/mental health in Portland, Oregon and active in the NPI registry since January 2021. The organization lists Susan N Mbugua, Mental Health Nurse Practitioner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Imani Mental Health And Wellness Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Imani Mental Health And Wellness LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Imani Mental Health And Wellness LLC's NPI number?
The NPI number for Imani Mental Health And Wellness LLC is 1104415405. It was assigned to this organization in the NPPES registry on January 12, 2021.
Where is Imani Mental Health And Wellness LLC located?
Imani Mental Health And Wellness LLC is located at 3939 NE Hancock St # 202, Portland, OR 97212. The listed phone number is (214) 458-1713.
What is Imani Mental Health And Wellness LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Imani Mental Health And Wellness LLC enrolled in Medicare?
Yes. Imani Mental Health And Wellness LLC is registered in the Medicare PECOS enrollment system.
When is Imani Mental Health And Wellness LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Oregon, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Imani Mental Health And Wellness LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Imani Mental Health And Wellness LLC. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Imani Mental Health And Wellness LLC accept?
Health plans from BridgeSpan Health Company, Moda Health Plan, Inc. and Regence BlueCross BlueShield of Oregon list Imani Mental Health And Wellness LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Imani Mental Health And Wellness LLC was last updated on January 25, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Imani Mental Health And Wellness Llc · NPI 1104415405
Psychiatric/Mental Health organization in Portland, Oregon. Organization record, active in the CMS NPPES registry since January 12, 2021.
## Identity
- **NPI:** 1104415405 (Entity type: Organization)
- **Enumerated:** January 12, 2021
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** No
- **Authorized official:** Susan Mbugua, MENTAL HEALTH NURSE PRACTITIONER
## Practice location
- **Address:** 3939 NE HANCOCK ST # 202, Portland, OR 97212-5321
- **Phone:** (214) 458-1713
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (Non-DME Part B, Oregon, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 25, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1104415405) · Data from the CMS NPPES public registry.