Innovative Medical Clinic

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

INNOVATIVE MEDICAL CLINIC

Practice address

3218 W Edgewood Dr
Ste 500
Jefferson City, MO 65109

Phone

(949) 696-6157

NPI assigned

Sep 19, 2023

Organization subpart

No

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

Authorized official

Name

Elochukwu OsoegoNPI 1639640055

Title

Owner

Phone

(949) 696-6157

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: eosoego@org151.direct.charmhealth.com

Practitioners 2

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

• Elochukwu Anthony Osoego, P.A.

  • Physician Assistant
  • Jefferson City, MO
  • NPI 1639640055
  Medicare reassignment Authorized official
• Dara Osoego, FNP

  • Family Nurse Practitioner
  • Columbia, MO
  • NPI 1518327790
  Medicare reassignment NPD

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

{
    "created_epoch": "1695081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695254400000",
    "number": "1063290260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3218 W EDGEWOOD DR",
            "address_2": "STE 500",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "65109",
            "telephone_number": "949-696-6157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3218 W EDGEWOOD DR",
            "address_2": "STE 500",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "65109",
            "telephone_number": "949-696-6157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-19",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A",
        "authorized_official_last_name": "OSOEGO",
        "authorized_official_first_name": "ELOCHUKWU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-696-6157"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rhonda Elaine Imhoff, O.T.
• Independent Living Resource Center, Inc.
• Indiana's Center for Foot and Ankle Care, P.C.
• Individualized Solutions, LLC
• Tammy L Inman, LPN
• Integrative Medicine, LLC
• Moriah Elizabeth Jackson
• Salma Hassan Jaegers
• Jehad Jafari, MD
• Sangeeta Jain-Roberts, M.D.

• Multi-Specialty Clinic/Center in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Multi-Specialty Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; 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.