Individual provider Active NPI

Mojisola M Ogunbuyide, C.R.N.A.

  • Certified Registered Nurse Anesthetist
  • Palos Heights, IL
National Provider Identifier
1194970020
Registry record updated Aug 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209007332 Issued in IL
Practice address
12251 S 80TH Ave
Palos Heights, IL 60463-1290
Phone
(708) 923-4000
Fax
(708) 923-8848
NPI assigned
Nov 19, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 209007332 IL Primary

Addresses

Primary practice location

12251 S 80TH Ave
Palos Heights, IL 60463-1290

Mailing address

12251 S 80TH Ave
Palos Heights, IL 60463-1290
Phone (708) 923-4000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081218000354 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 3274695655 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

12251 S 80TH Ave
Palos Heights, IL 60463-1290

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

  • Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Mar 2, 2021 Accepting new patients
Midwest Anesthesia Partners, LLC CurrentSince Aug 11, 2020 Accepting new patients
Ucm Medical Group Sub, LLC CurrentSince Nov 15, 2021 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Mar 2, 2021 Accepting new patients
Central Dupage Physician Group Past Accepting new patients
City of Hope Medical Group of Illinois PLLC Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

2900 N Lakeshore
Chicago, IL 60657
Phone (773) 665-3240

27702 Network Pl
Chicago, IL 60673

1 Ingalls Dr
Harvey, IL 60426
Phone (708) 333-2300

17800 Kedzie Ave
Hazel Crest, IL 60429
Phone (708) 213-4200

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

701 W North Ave
Melrose Park, IL 60160
Phone (708) 450-5779

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

12251 S 80th Ave
Palos Heights, IL 60463
Phone (708) 361-4500

6701 159th St
Tinley Park, IL 60477
Phone (708) 429-0222

Interoperability endpoints

  • Direct secure messaging: mogunbuyide224584@uchospital.direct-ci.com

Organizations & group practices 6

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 2

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": "1227052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628121600000",
    "number": "1194970020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12251 S 80TH AVE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631290",
            "telephone_number": "708-923-4000",
            "fax_number": "708-923-8848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12251 S 80TH AVE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631290",
            "telephone_number": "708-923-4000",
            "fax_number": "708-923-8848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGUNBUYIDE",
        "first_name": "MOJISOLA",
        "middle_name": "M",
        "credential": "C.R.N.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-19",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209007332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.