MRS. ANJELICA DUNLAP MAMUDU CRNA
NPI 1124734926
Nurse Anesthetist, Certified Registered in Detroit, MI

Q: What is Anjelica Dunlap Mamudu's NPI number?

The NPI number for Anjelica Dunlap Mamudu is 1124734926. It was assigned to this individual provider in the NPPES registry on January 25, 2023.

Q: What is Anjelica Dunlap Mamudu's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Active since January 25, 2023Accepts Medicare Assignment

22101 MOROSS RD, DETROIT, MI 48236(313) 343-4000 Get Directions Write a Review

NPPES record last updated: March 19, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Mrs. Anjelica Dunlap Mamudu Crna NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. ANJELICA DUNLAP MAMUDU CRNA (NPI 1124734926) is an individual nurse anesthetist, certified registered in Detroit, Michigan, licensed in Michigan (4704324253) and active in the NPI registry since January 2023. She is affiliated with Ascension St John Hospital and is a graduate of Other (2022).

NPPES Registry Identity

NPI1124734926

Entity TypeIndividualFemale

Primary Taxonomy367500000X

Provider Legal NameMRS. ANJELICA DUNLAP MAMUDUCredential: CRNA

Location Address22101 MOROSS RDDetroit, MI 48236-2148

Mailing Address23670 Radclift StOak Park, MI 48237-1932 · (248) 269-3255

Phone(313) 343-4000

Sole ProprietorYes

Medical School CMSOtherGraduated 2022

Enumeration DateJanuary 25, 2023

Last NPPES UpdateMarch 19, 2024

NPPES CertifiedMarch 19, 2024

✔ NPI 1124734926 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code367500000X

License✔ Licensed in MI · 4704324253

Definition

(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.

22101 MOROSS RD, Detroit, MI 48236

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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

Mrs. Anjelica Dunlap Mamudu Crna 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.

PECOS PAC ID9133592033

PECOS Enrollment IDI20230223001474

Medicare Billing Reassignment

Medicare enrollment records show Anjelica Dunlap Mamudu reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Henry Ford Health St. John Hospital

Same address

Nurse Anesthetist, Certified Registered

22101 MOROSS RD, SUITE 101
Detroit, MI 48236

Reassigned Medicare billing, Michigan enrollment
132 clinicians in this Medicare group

NPI 1598896995 (586) 753-0011

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Ascension St John Hospital

Acute Care Hospitals · Detroit, MI

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number230165

Location22101 Moross RdDetroit, MI 48236 · Wayne County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48236 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$134.28 typical visit price

range $58.04 – $177.36

Typical copayment $33.57 (range $14.51 – $44.34)

Most-billed visit code 99204

Established Patient

$72.38 typical visit price

range $18.32 – $143.49

Typical copayment $18.09 (range $4.58 – $35.87)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARY DECAROLIS LMSW, ACSW

Social Worker (Clinical)