NPIMap

Individual provider Active NPI

Ibikunle Adeola Ojebuoboh, M.D.

  • Internal Medicine Physician
  • Jacksonville, NC
National Provider Identifier
1093778276
Registry record updated Jul 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
9901455 Issued in NC
Practice address
22 Office Park Dr
Jacksonville, NC 28546-7325
Phone
(910) 219-4070
Fax
(910) 219-4071
NPI assigned
Apr 10, 2006
Last updated
Jul 28, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9901455 NC Primary

Addresses

Primary practice location

22 Office Park Dr
Jacksonville, NC 28546-7325

Mailing address

PO Box 12353
Jacksonville, NC 28546-2353
Phone (910) 219-4070

Other identifiers 2

IdentifierTypeStateIssuer
127XAOtherNCBLUE CROSS BLUE SHIELD
89127XAMedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060114000035 NC Practitioner - Internal Medicine 8921022153 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proactive Therapy of North Carolina IncGroup PAC ID 6305753120, shared by 5 NPIs, 540 clinicians

Practice addresses (Care Compare)

22 Office Park Dr
Jacksonville, NC 28546-7325
Phone (910) 219-4070

2303 Wellington Dr SW
Suite B
Wilson, NC 27893-8620
Phone (252) 243-6818

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Omni Clinic PA CurrentSince Dec 7, 2000 Accepting new patients

Locations

22 Office Park Dr
Jacksonville, NC 28546
Phone (910) 219-4070

Interoperability endpoints

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

Organizations & group practices 1

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

Hospital & facility affiliations 5

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": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217203200000",
    "number": "1093778276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12353",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285462353",
            "telephone_number": "910-219-4070",
            "fax_number": "910-219-4071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 OFFICE PARK DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467325",
            "telephone_number": "910-219-4070",
            "fax_number": "910-219-4071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OJEBUOBOH",
        "first_name": "IBIKUNLE",
        "middle_name": "ADEOLA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2008-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9901455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "127XA",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89127XA",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

Verify at the official NPI Registry.