NPIMap

Organization Active NPI

Augusta U. Ikhisemojie, M.D., a Professional Medical Corporation

Doing business as Omni Pain Clinic

  • Interventional Pain Medicine Physician
  • Riverside, CA
National Provider Identifier
1154412963
Registry record updated Sep 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
A67133 Issued in CA
Legal business name
AUGUSTA U. IKHISEMOJIE, M.D., A PROFESSIONAL MEDICAL CORPORATION
Doing business as
Omni Pain Clinic
Practice address
6485 Day St Ste 305
Riverside, CA 92507-0926
Phone
(951) 413-6433
Fax
(951) 413-6633
NPI assigned
Sep 27, 2006
Last updated
Sep 19, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2018

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

Authorized official

Name
Dr. Augusta Uayemen Ikhisemojie, M.D.NPI 1457389041
Title
President
Phone
(310) 276-1688

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X CA
Anesthesiology Physician 207L00000X A67133 CA
Interventional Pain Medicine Physician 208VP0014X A67133 CA Primary

Addresses

Primary practice location

6485 Day St Ste 305
Riverside, CA 92507-0926

Mailing address

PO Box 60790
Pasadena, CA 91116-6790
Phone (626) 795-6596

Other practice location 1

438 W Las Tunas Dr
San Gabriel, CA 91776-1216
Phone (626) 289-5454

Other names 1

  • Omni Pain Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080327000690 CA Part B Supplier - Clinic/Group Practice 4789760935 Receives reassigned benefits from 1 practitioner
Practice locations: Riverside, CA; San Gabriel, CA

National Provider Directory

National Provider Directory

Locations

6485 Day St
Ste 305
Riverside, CA 92507
Phone (951) 413-6433

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537315200000",
    "number": "1154412963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60790",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911166790",
            "telephone_number": "626-795-6596",
            "fax_number": "626-396-0851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6485 DAY ST STE 305",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925070926",
            "telephone_number": "951-413-6433",
            "fax_number": "951-413-6633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "438 W Las Tunas Dr",
            "address_purpose": "LOCATION",
            "city": "San Gabriel",
            "state": "CA",
            "postal_code": "917761216",
            "country_code": "US",
            "telephone_number": "626-289-5454",
            "fax_number": "626-570-6555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AUGUSTA U. IKHISEMOJIE, M.D., A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2018-09-19",
        "status": "A",
        "authorized_official_last_name": "IKHISEMOJIE",
        "authorized_official_first_name": "AUGUSTA",
        "authorized_official_middle_name": "UAYEMEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-276-1688",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A67133",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": "A67133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omni Pain Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Omni Pain Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.