Individual provider Active NPI

Obiageli Immaculata Esotu, MD

  • Family Medicine Physician
  • Saint Peters, MO
National Provider Identifier
1093095317
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2026030910 Issued in MO
Practice address
201 BJC Saint Peters Dr Ste 200
Saint Peters, MO 63376-3386
Phone
(636) 916-9615
Fax
(636) 916-9850
NPI assigned
Aug 17, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71003650A IN
Family Medicine Physician 207Q00000X 125081291 IL
Family Medicine Physician 207Q00000X 2026030910 MO Primary

Addresses

Primary practice location

201 BJC Saint Peters Dr Ste 200
Saint Peters, MO 63376-3386

Mailing address

PO Box 959354
Saint Louis, MO 63195-9354
Phone (636) 916-9615

Other practice location 1

612 N 11th St
Quincy, IL 62301-2662
Phone (217) 224-9484

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2 Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110901000279 IN Practitioner - Nurse Practitioner 0446420327

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71003650AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Siuphysicians & Surgeons, Inc. Current Accepting new patients
Physician Groups LC Family Medicine Past Accepting new patients

Locations

612 N 11th St
Quincy, IL 62301
Phone (217) 224-9484

Interoperability endpoints

  • Direct secure messaging: obiageliesotu@siu.allscriptsdirect.net

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": "1313539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784073600000",
    "number": "1093095317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 959354",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631959354",
            "telephone_number": "636-916-9615",
            "fax_number": "636-916-9850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 BJC SAINT PETERS DR STE 200",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633763386",
            "telephone_number": "636-916-9615",
            "fax_number": "636-916-9850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "612 N 11th St",
            "address_purpose": "LOCATION",
            "city": "Quincy",
            "state": "IL",
            "postal_code": "623012662",
            "country_code": "US",
            "telephone_number": "217-224-9484",
            "fax_number": "217-224-7950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ESOTU",
        "first_name": "OBIAGELI",
        "middle_name": "IMMACULATA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-17",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71003650A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125081291",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2026030910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "201 Bjc Saint Peters Dr Ste 200",
            "city": "Saint Peters",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633763386",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Peters, MO

Sources for this page

Verify at the official NPI Registry.