Individual provider Active NPI

Isoken Franca Ogbomo, FNP

  • Family Nurse Practitioner
  • Bolingbrook, IL
National Provider Identifier
1275049694
Registry record updated Sep 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209017025 Issued in IL
Practice address
1522 Schafer Ave
Bolingbrook, IL 60490-3230
Phone
(312) 451-6418
NPI assigned
Dec 21, 2017
Last updated
Sep 1, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209017025 IL Primary

Addresses

Primary practice location

1522 Schafer Ave
Bolingbrook, IL 60490-3230

Mailing address

402 W Boughton Rd Ste a
Bolingbrook, IL 60440-1998
Phone (312) 451-6418

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20201029000888 IL Practitioner - Nurse Practitioner 7416367636 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209017025ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vitae Health Medical Illinois, PLLC CurrentSince Jul 16, 2020 Accepting new patients
Complete Health Services Inc CurrentSince Jul 1, 2023 Accepting new patients
Gude Medical S C CurrentSince Sep 20, 2025 Accepting new patients
Bridgewell LLC CurrentSince Jul 1, 2023 Accepting new patients

Locations

402 W Boughton Rd
Ste A
Bolingbrook, IL 60440
Phone (312) 451-6418

2732 N Hampden Ct
Chicago, IL 60614
Phone (773) 248-6000

303 E Wacker Dr
Ste 1127
Chicago, IL 60601
Phone (312) 328-2347

Organizations & group practices 4

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": "1513814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1275049694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 W BOUGHTON RD STE A",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401998",
            "telephone_number": "312-451-6418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 SCHAFER AVE",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604903230",
            "telephone_number": "312-451-6418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGBOMO",
        "first_name": "ISOKEN",
        "middle_name": "FRANCA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-21",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209017025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

Verify at the official NPI Registry.