Organization Active NPI

Omo Ijesa PLLC

  • Internal Medicine Physician
  • Tucson, AZ
National Provider Identifier
1003436197
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
OMO IJESA PLLC
Practice address
7309 E 28TH St
Tucson, AZ 85710-5505
Phone
(510) 345-8981
Fax
(520) 253-7229
NPI assigned
Apr 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Akinbola Adewole Ajayi-Obe, MDNPI 1265850549
Title
Owner
Phone
(510) 345-8981

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

7309 E 28TH St
Tucson, AZ 85710-5505

Mailing address

PO Box 7362
McMinnville, TN 37111-7362
Phone (510) 345-8981

Other names 1

  • Ibi Arojinle Institut fur Gesundheit Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250106002896 MD Part B Supplier - Clinic/Group Practice 4183156847 Receives reassigned benefits from 1 practitioner
Practice locations: Lanham, MD

National Provider Directory

National Provider Directory

Locations

4600 Forbes Blvd
Ste A26301
Lanham, MD 20706
Phone (510) 345-8981

4600 Forbes Blvd
Ste 301
Lanham, MD 20706

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1003436197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7362",
            "city": "MCMINNVILLE",
            "state": "TN",
            "postal_code": "371117362",
            "telephone_number": "510-345-8981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7309 E 28TH ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857105505",
            "telephone_number": "510-345-8981",
            "fax_number": "520-253-7229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMO IJESA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-20",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "AJAYI-OBE",
        "authorized_official_first_name": "AKINBOLA",
        "authorized_official_middle_name": "ADEWOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "510-345-8981",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ibi Arojinle Institut fur Gesundheit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.