PROVIDENCE HEALTH GROUP LLC
NPI 1205773264
Nurse Practitioner - Psychiatric/Mental Health in Bowie, MD
About Providence Health Group Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PROVIDENCE HEALTH GROUP LLC (NPI 1205773264) is a healthcare organization registered as a psychiatric/mental health in Bowie, Maryland and active in the NPI registry since April 2026. The organization lists Ijeoma Mgboji, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Providence Health Group Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Providence Health Group 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 Providence Health Group LLC's NPI number?
The NPI number for Providence Health Group LLC is 1205773264. It was assigned to this organization in the NPPES registry on April 29, 2026.
Where is Providence Health Group LLC located?
Providence Health Group LLC is located at 3060 Mitchellville Rd # 6-A, Bowie, MD 20716. The listed phone number is (908) 906-7518.
What is Providence Health Group LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Providence Health Group LLC enrolled in Medicare?
Yes. Providence Health Group LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Providence Health Group LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Providence Health Group 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.
When was this NPI record last updated?
The NPPES record for Providence Health Group LLC was last updated on August 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.
# Providence Health Group Llc · NPI 1205773264
Psychiatric/Mental Health organization in Bowie, Maryland. Organization record, active in the CMS NPPES registry since April 29, 2026.
## Identity
- **NPI:** 1205773264 (Entity type: Organization)
- **Enumerated:** April 29, 2026
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** No
- **Authorized official:** Ijeoma Mgboji, OWNER
## Practice location
- **Address:** 3060 MITCHELLVILLE RD # 6-A, Bowie, MD 20716-1389
- **Phone:** (908) 906-7518
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **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:** August 6, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1205773264) · Data from the CMS NPPES public registry.