NPIMap

Individual provider Active NPI

Shamusideen Olayibo Ogbulu, MD

  • Hospitalist Physician
  • Whiteville, NC
National Provider Identifier
1144478736
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
2011-01350 Issued in NC
Practice address
500 Jefferson Street
Whiteville, NC 28472-3634
Phone
(910) 642-1776
NPI assigned
Sep 8, 2008
Last updated
Aug 23, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01065806A IN
Internal Medicine Physician 207R00000X 2011-01350 NC
Hospitalist Physician 208M00000X 0101258916 VA
Hospitalist Physician 208M00000X 01065806A IN
Hospitalist Physician 208M00000X 2011-01350 NC Primary

Addresses

Primary practice location

500 Jefferson Street
Whiteville, NC 28472-3634

Mailing address

PO Box 601992
Charlotte, NC 28260-1992
Phone (910) 642-1776

Other practice location 1

1755 N Mecklenburg Ave
South Hill, VA 23970-4080
Phone (434) 447-3151

Other identifiers 5

IdentifierTypeStateIssuer
NC1486MedicaidSC
000000584350OtherINANTHEM PIN
5918627MedicaidNC
P00657204OtherINRR MEDICARE PIN
200913430MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111026000946 NC Practitioner - Internal Medicine 4688741812 Reassigns benefits to 2 organizations
I20170315002527 VA Practitioner - Internal MedicinePractitioner - Hospitalist 4688741812 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Practice addresses (Care Compare)

1250 E Marshall St
Richmond, VA 23219-5051
Phone (804) 828-9000

500 Academy St S
Vidant Roanoke Chowan Hospitalists
Ahoskie, NC 27910-3248
Phone (252) 209-3708

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
83.95 of 100Reported as group
Quality
69.91
Promoting interoperability
99
Improvement activities
40
Cost
77.42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01065806AINMDInternal Medicine Physician
2011-01350NCMDInternal Medicine Physician
0101258916VAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Physician Services Inc CurrentSince Dec 20, 2016 Accepting new patients
CMH Physician Services, LLC Internal Medicine Current Accepting new patients
Riverside Physician Services Inc Current Accepting new patients
CMH Physician Services, LLC Hospitalist CurrentSince Jul 3, 2023 Accepting new patients
Vidant Medical Group LLC CurrentSince Jul 1, 2012 Accepting new patients
Cogent Healthcare of North Carolina, PC Internal Medicine CurrentSince May 22, 2023 Accepting new patients
Lake Spring Physician Services, LLC Hospitalist CurrentSince Jul 15, 2018 Accepting new patients
Riverside Physician Services, Inc. Internal Medicine CurrentSince Dec 20, 2016 Accepting new patients
MCV Associated Physicians CurrentSince Jul 1, 2024 Accepting new patients
Ingleside Physician Services, LLC Hospitalist CurrentSince Jul 15, 2018 Accepting new patients
NC Comprehensive Hospitalists PLLC Hospitalist Past Accepting new patients
Columbus Regional Health Network Internal Medicine Past Accepting new patients
Columbus Regional Health Network Past Accepting new patients
Columbus Regional Health Network Past Accepting new patients

Locations

500 Academy St S
Ahoskie, NC 27910
Phone (252) 209-3000

1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000

317 Western Blvd
Jacksonville, NC 28546
Phone (910) 577-2240

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

1 Arh Ln
Low Moor, VA 24457
Phone (540) 345-2593

856 J Clyde Morris Blvd
Ste A
Newport News, VA 23601
Phone (757) 316-5900

858 J Clyde Morris Blvd
Newport News, VA 23601
Phone (757) 594-4343

500 J Clyde Morris Blvd
North North, VA 23601
Phone (757) 594-2000

1250 E Marshall St
Richmond, VA 23298
Phone (804) 628-6990

401 N 11th St
Richmond, VA 23219
Phone (804) 828-4409

1900 Electric Rd
Salem, VA 24153
Phone (540) 772-3400

1755 N Mecklenburg Ave
South Hill, VA 23970
Phone (434) 584-2273

Interoperability endpoints

  • Direct secure messaging: sogbulu41967@direct.ecuhealth.com

Organizations & group practices 14

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.

View all 14

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": "1220832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1144478736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601992",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601992",
            "telephone_number": "910-642-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 JEFFERSON STREET",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284723634",
            "telephone_number": "910-642-1776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1755 N Mecklenburg Ave",
            "address_purpose": "LOCATION",
            "city": "South Hill",
            "state": "VA",
            "postal_code": "239704080",
            "country_code": "US",
            "telephone_number": "434-447-3151",
            "fax_number": "434-584-5023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OGBULU",
        "first_name": "SHAMUSIDEEN",
        "middle_name": "OLAYIBO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-08",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01065806A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2011-01350",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "VA",
            "license": "0101258916",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "01065806A",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NC",
            "license": "2011-01350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NC1486",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000584350",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5918627",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "P00657204",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200913430",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiteville, NC

Sources for this page

Verify at the official NPI Registry.