Active NPI
Jideofor Ebony Obodozie, MD
- Critical Care Medicine (Internal Medicine) Physician
- Daytona Beach, FL
National Provider Identifier
1124517289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Medicine (Internal Medicine) Physician
- License
- ME165936
- Practice address
- 301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167 - Phone
- (386) 231-6000
- NPI assigned
- May 4, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 2021048898 | MO | |
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | ME165936 | FL | Primary |
Addresses
Primary practice location
301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167
Mailing address
901 Sterthaus Dr
Ormond Beach, FL 32174-5133
Other practice location 1
124 Colton Dr
Daytona Beach, FL 32117-5621
Phone (210) 789-9296
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240625001438 | FL | Practitioner - Critical Care (Intensivists) | 4183033632 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Critical Care (Intensivists)
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Florida Hospital Healthcare Partners, Inc
Practice addresses (Care Compare)
301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167
Phone (386) 231-6000
Hospital & facility affiliations
- Adventhealth Daytona Beach
- Adventhealth Palm Coast Parkway
- AdventHealth Palm Coast
- Adventhealth Orlando
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021048898 | MO | MD | Internal Medicine Physician |
Practice roles (1 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Hospital Healthcare Partners, Inc | Internal Medicine | Current | Accepting new patients |
Locations
301 Memorial Medical Pkwy
Holly Hill, FL 32117
Phone (386) 231-3906
1055 Saxon Blvd
Orange City, FL 32763
Phone (386) 917-5000
901 Sterthaus Dr
Ormond Beach, FL 32174
Phone (386) 206-5908
60 Memorial Medical Pkwy
Palm Coast, FL 32164
Phone (385) 586-2000
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Interoperability endpoints
- jobodozie3543449@adventhealth.direct-ci.com
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 and National Provider Directory roles.
-
- Internal Medicine Physician
- Daytona Beach, FL
- NPI 1780100529
FL, Internal Medicine
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Palm Coast, FL
- NPI 1861102345
Hospital
-
- General Acute Care Hospital
- Orlando, FL
- NPI 1306938071
Hospital
-
- Clinical Medical Laboratory
- Orlando, FL
- NPI 1801569728
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717891200000",
"number": "1124517289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 STERTHAUS DR",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321745133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 MEMORIAL MEDICAL PKWY",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321175167",
"telephone_number": "386-231-6000"
}
],
"practiceLocations": [
{
"address_1": "124 Colton Dr",
"address_purpose": "LOCATION",
"city": "Daytona Beach",
"state": "FL",
"postal_code": "321175621",
"country_code": "US",
"telephone_number": "210-789-9296",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OBODOZIE",
"first_name": "JIDEOFOR",
"middle_name": "EBONY",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-04",
"last_updated": "2024-06-09",
"certification_date": "2024-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "2021048898",
"primary": false
},
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "FL",
"license": "ME165936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.