NPIMap

Individual provider Active NPI

Cora O Ogbolu, MD

  • Nephrology Physician
  • Iselin, NJ
National Provider Identifier
1164429361
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
324972 Issued in NY
Practice address
400 Gill LN
Iselin, NJ 08830-3001
Phone
(732) 404-1580
Fax
(732) 404-1594
NPI assigned
Jul 1, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA07727300 NJ
Nephrology Physician 207RN0300X 324972 NY Primary

Addresses

Primary practice location

400 Gill LN
Iselin, NJ 08830-3001

Mailing address

400 Gill LN
Iselin, NJ 08830-3001
Phone (732) 404-1580

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230920001241 NY Practitioner - Internal MedicinePractitioner - Nephrology 4183602220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 1993
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

62 Hackett Blvd
Albany, NY 12209-1756

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
18.99 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
63.29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA07727300NJMDInternal Medicine Physician
001539NYMDArt Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Avenel Iselin Medical Group, LLC Nephrology Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: cogbolu@nenephrology.medentdirect.com

Organizations & group practices 2

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.

Hospital & facility affiliations 9

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": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1164429361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 GILL LN",
            "city": "ISELIN",
            "state": "NJ",
            "postal_code": "088303001",
            "telephone_number": "732-404-1580",
            "fax_number": "732-404-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 GILL LN",
            "city": "ISELIN",
            "state": "NJ",
            "postal_code": "088303001",
            "telephone_number": "732-404-1580",
            "fax_number": "732-404-1594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGBOLU",
        "first_name": "CORA",
        "middle_name": "O",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-01",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07727300",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "324972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Iselin, NJ

Sources for this page

Verify at the official NPI Registry.