Raphael Omoto, CNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

9968 Issued in MN

Practice address

2215 E Lake St
Minneapolis, MN 55407-4385

Phone

(612) 596-9438

NPI assigned

Feb 27, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Raphael Omoto Professional name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hennepin CountyGroup PAC ID 7911892849, 132 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

Practice roles

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.

• Hennepin County

  • Psychiatry Physician
  • Minneapolis, MN
  • NPI 1780790345
  Medicare reassignment Care Compare group
• Gerard Treatment Programs

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Austin, MN
  • NPI 1972650893
  NPD (past)

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

{
    "created_epoch": "1677456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775088000000",
    "number": "1245939495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7420 UNITY AVE N STE 310C",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554433162",
            "telephone_number": "612-212-2595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 E LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554074385",
            "telephone_number": "612-596-9438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMOTO",
        "first_name": "RAPHAEL",
        "name_prefix": "Mr.",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-02-27",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "9968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAPHAEL",
            "last_name": "OMOTO",
            "prefix": "MR.",
            "credential": "CNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ugbad Abdi Omer
• Zabiti A Omer, LPN
• Hillary Omisakin, NP
• Lilian Omodi, CNP
• Jean Renae Omodt, PT
• Christine Omwega
• On Call Clinicians
• On Call Clinicians, Inc.
• On Point Home Health Care
• On Site Interpreters

• Psychiatric/Mental Health Nurse Practitioner in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.