NPIMap

Individual provider Active NPI

Michael Ebhota Okogbo, MD

  • Pediatrics Physician
  • Conroe, TX
National Provider Identifier
1043224132
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
K4516 Issued in TX
Practice address
15210 I-45 S
Suite 110
Conroe, TX 77384-4105
Phone
(936) 270-8655
Fax
(936) 270-8739
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X K4516 TX Primary

Addresses

Primary practice location

15210 I-45 S
Suite 110
Conroe, TX 77384-4105

Mailing address

15210 I-45 South
Suite 110
Conroe, TX 77384-4105
Phone (936) 270-8655

Other identifiers 4

IdentifierTypeStateIssuer
125748707MedicaidTX
200134400 AMedicaidOK
125748708OtherTXCSHCN
67022383MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
K4516TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Pediatrics Associates, PA Pediatrics Past Accepting new patients
Acs Primary Care Physicians Southwest, PA Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ECCJAD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493337600000",
    "number": "1043224132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15210 I-45 SOUTH",
            "address_2": "SUITE 110",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773844105",
            "telephone_number": "936-270-8655",
            "fax_number": "936-270-8739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15210 I-45 S",
            "address_2": "SUITE 110",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773844105",
            "telephone_number": "936-270-8655",
            "fax_number": "936-270-8739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKOGBO",
        "first_name": "MICHAEL",
        "middle_name": "EBHOTA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2017-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "K4516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125748707",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200134400 A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "125748708",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "67022383",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.