Active NPI
Omonigho Ejobotodo
- Non-emergency Medical Transport (VAN)
- Indianapolis, IN
National Provider Identifier
1124735212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Non-emergency Medical Transport (VAN)
- License
- 5400369113
- Practice address
- 7360 Aruba LN Apt B
Indianapolis, IN 46214-1110 - Phone
- (317) 658-5764
- NPI assigned
- Oct 31, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Non-emergency Medical Transport (VAN) | 343900000X | 5400369113 | IN | Primary |
Addresses
Primary practice location
7360 Aruba LN Apt B
Indianapolis, IN 46214-1110
Mailing address
7360 Aruba LN Apt B
Indianapolis, IN 46214-1110
Phone (317) 658-5764
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5400369113 | IN | MD | Non-emergency Medical Transport (VAN) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667174400000",
"number": "1124735212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7360 ARUBA LN APT B",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462141110",
"telephone_number": "317-658-5764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7360 ARUBA LN APT B",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462141110",
"telephone_number": "317-658-5764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EJOBOTODO",
"first_name": "OMONIGHO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-31",
"last_updated": "2022-10-31",
"certification_date": "2022-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "343900000X",
"taxonomy_group": "",
"desc": "Non-emergency Medical Transport (VAN)",
"state": "IN",
"license": "5400369113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.