NPIMap

Individual provider Active NPI

Omolola Ajoke Omotoso, MD

  • Internal Medicine Physician
  • Moncks Corner, SC
National Provider Identifier
1154514529
Registry record updated Jul 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
063694 Issued in GA
Practice address
110 Executive Parkway
Moncks Corner, SC 29461
Phone
(843) 899-9099
Fax
(843) 899-9091
NPI assigned
Aug 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MT185765 PA
Internal Medicine Physician 207R00000X 31061 SC
Hospitalist Physician 208M00000X 2016004893 MO
Internal Medicine Physician 207R00000X 063694 GA Primary

Addresses

Primary practice location

110 Executive Parkway
Moncks Corner, SC 29461

Mailing address

PO Box 1116
Moncks Corner, SC 29461-1116
Phone (843) 899-9099

Other practice location 1

3015 N Ballas Rd
Saint Louis, MO 63131-2329
Phone (314) 996-5772

Other practice location 2

1101 W Liberty St
Farmington, MO 63640-1921
Phone (573) 705-1272

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2 Health Information Exchange (HIE)
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, MO, TN3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20140716002105 GA Practitioner - Internal MedicinePractitioner - Hospitalist 4183781420 Reassigns benefits to 2 organizations
I20160314000288 MO Practitioner - HospitalistPractitioner - Internal Medicine 4183781420 Reassigns benefits to 8 organizations
I20190606001791 TN Practitioner - Hospitalist 4183781420 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 1999
Medicare assignment
May accept Medicare assignment
Group practices
Mercy Clinic Joplin LLCGroup PAC ID 0547300196, 288 clinicians
Apogee Medical Group GeorgiaGroup PAC ID 4587676945, 122 clinicians

Practice addresses (Care Compare)

100 Mercy Way
Mercy Clinic Joplin Hospitalists
Joplin, MO 64804-4524
Phone (417) 556-3754

705 Dixie St
Carrollton, GA 30117-3818
Phone (770) 812-9666

PO Box
Suite 1257
Hannibal, MO 63401-1257
Phone (573) 248-5460

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
063694GAMDInternal Medicine Physician
MT185765PAMDInternal Medicine Physician
31061SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities Internal Medicine CurrentSince Jul 15, 2016 Accepting new patients
Hannibal Regional Healthcare System Inc CurrentSince Mar 10, 2020 Accepting new patients
Galen Inpatient Physicians PC. Internal Medicine CurrentSince Nov 18, 2019 Accepting new patients
App of Tennessee HM, PLLC Hospitalist CurrentSince Jul 1, 2019 Accepting new patients
Hospital Physician Services - Southeast Professional Corporation Hospitalist CurrentSince Jul 31, 2019 Accepting new patients
Dunn Physician Services, LLC Hospitalist CurrentSince Jun 1, 2025 Accepting new patients
Galen Inpatient Physicians PC Hospitalist CurrentSince Nov 18, 2019 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Sep 19, 2016 Accepting new patients
Apogee Medical Group Georgia Internal Medicine CurrentSince Jun 1, 2021 Accepting new patients
Tift Regional Health System Inc CurrentSince Feb 5, 2016 Accepting new patients
Butler Physician Services, LLC Internal Medicine CurrentSince Jul 18, 2021 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jul 15, 2016 Accepting new patients
Cole Physician Services LLC Hospitalist CurrentSince Dec 3, 2021 Accepting new patients
Liberty Doctors LLC Internal Medicine Past Accepting new patients
Mercy Hospital Joplin Past Accepting new patients
Hannibal Regional Healthcare System, Inc Past Accepting new patients

Locations

15059 N Scottsdale Rd
Ste 600
Scottsdale, AZ 85254
Phone (602) 778-3601

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

705 Dixie St
Carrollton, GA 30117
Phone (770) 812-9666

501 Redmond Rd NW
Rome, GA 30165
Phone (706) 291-0291

1700 Medical Way
Snellville, GA 30078
Phone (770) 978-4229

2225 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-3422

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

1900 Tebeau St
Waycross, GA 31501
Phone (912) 283-3030

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

10 S Hospital Dr
Fulton, MO 65251
Phone (573) 592-6550

6000 Hospital Dr
Hannibal, MO 63401
Phone (573) 248-5460

6000 Hospital Dr
#1257
Hannibal, MO 63401
Phone (573) 248-5460

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

2316 E Meyer Blvd
Kansas City, MO 64132
Phone (816) 276-4360

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

3100 Oak Grove Rd
Rombauer, MO 63901
Phone (573) 776-2000

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

106 Medical Center Blvd
Fayetteville, TN 37334
Phone (931) 438-1100

2835 Highway 231 N
Shelbyville, TN 37160
Phone (931) 685-5433

Interoperability endpoints

  • Direct secure messaging: omola.omotoso@oconeeregional.gadirect.net
  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602
  • Direct secure messaging: oomotoso554611@ahs.direct-ci.com

Organizations & group practices 18

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.

View all 18

Hospital & facility affiliations 7

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": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782864000000",
    "number": "1154514529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1116",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294611116",
            "telephone_number": "843-899-9099",
            "fax_number": "843-899-9091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 EXECUTIVE PARKWAY",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "29461",
            "telephone_number": "843-899-9099",
            "fax_number": "843-899-9091"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3015 N Ballas Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631312329",
            "country_code": "US",
            "telephone_number": "314-996-5772",
            "fax_number": "314-996-5772",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1101 W Liberty St",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "MO",
            "postal_code": "636401921",
            "country_code": "US",
            "telephone_number": "573-705-1272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OMOTOSO",
        "first_name": "OMOLOLA",
        "middle_name": "AJOKE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-20",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT185765",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "31061",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2016004893",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "063694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3015 N Ballas Rd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631312329",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1101 W Liberty St",
            "city": "Farmington",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636401921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Moncks Corner, SC

Sources for this page

Verify at the official NPI Registry.