Individual provider Active NPI

Chisom Ofodire, MD

  • Family Medicine Physician
  • Sacramento, CA
National Provider Identifier
1225523087
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A173586 Issued in CA
Practice address
3000 Q St
Sacramento, CA 95816-7058
Phone
(916) 733-3440
NPI assigned
Jun 25, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X A173586 CA Primary

Addresses

Primary practice location

3000 Q St
Sacramento, CA 95816-7058

Mailing address

3000 Q St
Sacramento, CA 95816-7058
Phone (916) 733-3440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211221001083 CA Practitioner - Family Practice 7315378809 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dignity Health Medical FoundationGroup PAC ID 7810800661, 1,211 clinicians

Practice addresses (Care Compare)

3000 Q St
FL 2
Sacramento, CA 95816-7058
Phone (916) 560-0319

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A173586CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Single Specialty Current Accepting new patients
Dignity Health Medical Foundation Single Specialty Current Accepting new patients
Sutter Valley Medical Foundation CurrentSince Apr 1, 2022 Accepting new patients
Dignity Health Medical Foundation Single Specialty CurrentSince Sep 16, 2021 Accepting new patients
Sutter Valley Medical Foundation Family Medicine CurrentSince Apr 1, 2022 Accepting new patients
Dignity Health Medical Foundation CurrentSince Sep 16, 2021 Accepting new patients
Dignity Health Medical Foundation Past Accepting new patients
Duke Health Lake Norman Regional Medical Center, Inc. Past Accepting new patients

Locations

9394 Big Horn Blvd
Elk Grove, CA 95758
Phone (916) 351-4800

815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900

3980 Douglas Blvd
Ste 110
Roseville, CA 95661
Phone (916) 293-4400

3000 Q St
Fl 1
Sacramento, CA 95816
Phone (916) 733-3301

3000 Q St
Sacramento, CA 95816
Phone (916) 733-5701

3000 Q St
Fl 2
Sacramento, CA 95816
Phone (916) 733-3323

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

Interoperability endpoints

  • Direct secure messaging: cofodire615360@hisp.ehr.sutterhealth.org

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1225523087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 Q ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958167058",
            "telephone_number": "916-733-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 Q ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958167058",
            "telephone_number": "916-733-3440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OFODIRE",
        "first_name": "CHISOM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-25",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A173586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.