Individual provider Active NPI

Ismail Olusayo Oshogwemoh, D.O.

  • Obstetrics & Gynecology Physician
  • Urbana, IL
National Provider Identifier
1053626705
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036144737 Issued in IL
Practice address
611 W Park St
Urbana, IL 61801-2529
Phone
(217) 383-3140
Fax
(217) 383-4966
NPI assigned
Aug 18, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 58.003593 OH
Orthopaedic Surgery Physician 207X00000X 006762 AZ
Obstetrics & Gynecology Physician 207V00000X 036144737 IL Primary

Addresses

Primary practice location

611 W Park St
Urbana, IL 61801-2529

Mailing address

611 W Park St
Fapc
Urbana, IL 61801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200303001678 CA Practitioner - Obstetrics/Gynecology 3274854880 Reassigns benefits to 1 organization
I20210106001221 IL Practitioner - Obstetrics/Gynecology 3274854880 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036144737ILMDObstetrics & Gynecology Physician
58.003593OHMDObstetrics & Gynecology Physician
006762AZMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Richland Memorial Hospital, Inc CurrentSince Jun 2, 2022 Accepting new patients
Obhg California, P.C. Family Medicine CurrentSince Jan 16, 2020 Accepting new patients
Carle Health Care Incorporated Family Medicine CurrentSince Nov 2, 2020 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Richland Memorial Hospital, Inc Current Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jun 1, 2024 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Sun Life Family Health Center, Inc. Past Accepting new patients
Sun Life Family Health Center, Inc Past Accepting new patients
Carle Health Care Incorporated Past Accepting new patients
The Carle Foundation Hospital Past Accepting new patients
Sun Life Family Health Center, Inc. Past Accepting new patients

Locations

400 Old River Rd
Bakersfield, CA 93311
Phone (661) 663-6000

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1509 Wilson Ter
Glendale, CA 91206
Phone (818) 409-8071

100 W California Blvd
Pasadena, CA 91105
Phone (626) 397-3445

215 W Janss Rd
Thousand Oaks, CA 91360
Phone (805) 379-5435

900 E Scott St
Olney, IL 62450
Phone (618) 345-1000

815 Main St
Ste A1
Peoria, IL 61602

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

1201 Ricker Rd
Salem, IL 62881
Phone (618) 548-3194

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

777 Lowndes Hill Rd
Bldg 1
Greenville, SC 29607
Phone (864) 908-3736

Interoperability endpoints

  • Direct secure messaging: ioshogwemohmd317226@carlehiedirect.net

Organizations & group practices 12

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1282089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1053626705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "address_2": "FAPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012529",
            "telephone_number": "217-383-3140",
            "fax_number": "217-383-4966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSHOGWEMOH",
        "first_name": "ISMAIL",
        "middle_name": "OLUSAYO",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-18",
        "last_updated": "2021-04-12",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "58.003593",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AZ",
            "license": "006762",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036144737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

Verify at the official NPI Registry.