Individual provider Active NPI

Mojirayo A. Sarumi, D.O.

  • Maternal & Fetal Medicine Physician
  • Tyler, TX
National Provider Identifier
1134557952
Registry record updated Mar 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X
License
R9538 Issued in TX
Practice address
620 S Fleishel Ave
Tyler, TX 75701
Phone
(903) 606-4900
Fax
(903) 606-4699
NPI assigned
Oct 15, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X R9538 TX
Obstetrics & Gynecology Physician 207V00000X OS017932 PA
Obstetrics & Gynecology Physician 207V00000X 25MB09374900 NJ
Maternal & Fetal Medicine Physician 207VM0101X R9538 TX Primary

Addresses

Primary practice location

620 S Fleishel Ave
Tyler, TX 75701

Mailing address

2900 Saint Michael Dr Ste 401
Texarkana, TX 75503-5211
Phone (903) 614-5383

Other practice location 1

1001 S George St
York, PA 17403-3676
Phone (717) 851-2345

Other practice location 2

1001 S George St
York, PA 17403-3676
Phone (717) 851-2345

Other identifiers 3

IdentifierTypeStateIssuer
825668OtherTXMEDICARE PIN
0464660MedicaidNJ
400935901MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190718001977 TX Practitioner - Obstetrics/Gynecology 8426369125 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Philadelphia College of Osteopathic Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

1720 S Beckham Ave
104 Christus Trinity Clinic
Tyler, TX 75701-4464
Phone (903) 597-2002

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MB09374900NJMDObstetrics & Gynecology Physician
OS017932PAMDObstetrics & Gynecology Physician
R9538TXMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trincare Inc Current Accepting new patients
Christus Trinity Clinic Texas CurrentSince Aug 26, 2019 Accepting new patients
Christus Trinity Clinic Texas Obstetrics & Gynecology CurrentSince Aug 26, 2019 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Aug 26, 2019 Accepting new patients

Locations

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

620 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-1193

1720 S Beckham Ave
Ste 104
Tyler, TX 75701
Phone (903) 597-2002

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

Organizations & group practices 4

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": "1381795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583107200000",
    "number": "1134557952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 SAINT MICHAEL DR STE 401",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755035211",
            "telephone_number": "903-614-5383",
            "fax_number": "903-614-5343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75701",
            "telephone_number": "903-606-4900",
            "fax_number": "903-606-4699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 S George St",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174033676",
            "country_code": "US",
            "telephone_number": "717-851-2345",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 S George St",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174033676",
            "country_code": "US",
            "telephone_number": "717-851-2345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SARUMI",
        "first_name": "MOJIRAYO",
        "middle_name": "A.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-15",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "R9538",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "OS017932",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "25MB09374900",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "TX",
            "license": "R9538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "825668",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0464660",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400935901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.