MAFON FOMUJANG (NURSE PRACTITIONER) – Psychiatric/Mental Health Nurse Practitioner, NPI 1013442102
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
14,984 NURSE PRACTITIONER in OH
Provider Addresses for MAFON FOMUJANG (NURSE PRACTITIONER)
10 Salt Creek Run
Peninsula, OH 442649461
Phone: (405) 549-6290
Type: Location
12395 McCracken Rd Ste A
Garfield Heights, OH 441252946
Phone: (216) 587-6727
Type: Location
1930 Fulton Rd NW # 103
Canton, OH 447093526
Phone: (330) 956-5936
Fax: (330) 956-5623
Type: Location
13422 Kinsman Rd
Cleveland, OH 441204410
Phone: (866) 536-6038
Type: Location
Murtis Taylor Human Services System, 13422, Kinsman Road, Mount Pleasant, Cleveland, Cuyahoga County, Ohio, 44120, United States
CLEVELAND, OH 441204410
Phone: (866) 536-6038
Type: Location
10 SALT CREEK RUN
PENINSULA, OH 442649461
Phone: (405) 549-6290
Type: Mailing
32638 HARVEST VALLEY DR
BROOKSHIRE, TX 774232908
Phone:
Type: Mailing
2911 MEDICAL ARTS ST STE 10
AUSTIN, TX 787053302
Phone: (866) 473-0663
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-05-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20181107002813 | I | Nurse Practitioner | OH | TBD |
| I20230502002528 | I | Nurse Practitioner | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 44264)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Mental Health Counselor | TX | |
| Mental Health Counselor | TX | |
| Clinical Social Worker | OH | |
| Clinical Social Worker | IL | |
| Mental Health Counselor | GA | |
| Mental Health Counselor | TX | |
| Mental Health Counselor | TX | |
| Mental Health Counselor | IL | |
| Mental Health Counselor | TX | |
| Nurse Practitioner | IL |
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