NPIMap

Individual provider Active NPI

Odochi N Nwagwu, MD

  • Pediatrics Physician
  • Adelanto, CA
National Provider Identifier
1225010903
Registry record updated Jun 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
G77049 Issued in CA
Practice address
11678 Rancho Rd
Adelanto, CA 92301-2700
Phone
(760) 246-9555
Fax
(760) 246-9115
NPI assigned
Nov 17, 2005
Reactivated
Jul 26, 2007
Last updated
Jun 20, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X G77049 CA
Pediatrics Physician 208000000X G77049 CA Primary

Addresses

Primary practice location

11678 Rancho Rd
Adelanto, CA 92301-2700

Mailing address

11678 Rancho Rd
Adelanto, CA 92301-2700
Phone (760) 246-9555

Other identifiers 2

IdentifierTypeStateIssuer
4501031MedicaidCA
00G770491MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ala-Ngwa American ENT.Inc. Specialist Past Accepting new patients
St. Mary Medical Center Past Accepting new patients
Odochi Nwagwu MD Inc Past Accepting new patients
Community Hospital of San Bernardino Past Accepting new patients
Desert Valley Hospital, LLC Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AIFEAA/Endpoint/AIFEAA

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371686400000",
    "number": "1225010903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11678 RANCHO RD",
            "city": "ADELANTO",
            "state": "CA",
            "postal_code": "923012700",
            "telephone_number": "760-246-9555",
            "fax_number": "760-246-9115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11678 RANCHO RD",
            "city": "ADELANTO",
            "state": "CA",
            "postal_code": "923012700",
            "telephone_number": "760-246-9555",
            "fax_number": "760-246-9115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWAGWU",
        "first_name": "ODOCHI",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-17",
        "last_updated": "2013-06-20",
        "deactivation_date": "2007-07-17",
        "reactivation_date": "2007-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G77049",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G77049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4501031",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G770491",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Adelanto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.