NPIMap

Individual provider Active NPI

Eni Clement Okonofua, M.B.,B.S.

  • Internal Medicine Physician
  • North Charleston, SC
National Provider Identifier
1295770436
Registry record updated Oct 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
21076 Issued in SC
Practice address
5390 Dorchester Rd
North Charleston, SC 29418-5652
Phone
(843) 552-3099
Fax
(846) 559-9037
NPI assigned
Jun 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 21076 SC Primary

Addresses

Primary practice location

5390 Dorchester Rd
North Charleston, SC 29418-5652

Mailing address

5390 Dorchester Rd
N Charleston, SC 29418-5652
Phone (843) 552-3099

Other identifiers 2

IdentifierTypeStateIssuer
T53518MedicaidSC
134323946OtherSCBCBS OF SC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061025000510 SC Practitioner - Internal Medicine 0941207427 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5390 Dorchester Rd
North Charleston, SC 29418-5652
Phone (843) 552-3099

Hospital & facility affiliations

  • Roper-St. Francis Home Health Home health agency, Charleston, SC, CCN 427042
  • Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065
  • Trident Medical Center Hospital, Charleston, SC, CCN 420079
  • Roper Hospital Hospital, Charleston, SC, CCN 420087
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Medical Center, Inc CurrentSince Sep 27, 2006 Accepting new patients

Locations

5390 Dorchester Rd
North Charleston, SC 29418
Phone (843) 552-3099

Organizations & group practices 1

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 10

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": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569888000000",
    "number": "1295770436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5390 DORCHESTER RD",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294185652",
            "telephone_number": "843-552-3099",
            "fax_number": "843-552-3277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5390 DORCHESTER RD",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294185652",
            "telephone_number": "843-552-3099",
            "fax_number": "846-559-9037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKONOFUA",
        "first_name": "ENI",
        "middle_name": "CLEMENT",
        "name_prefix": "Dr.",
        "credential": "M.B.,B.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2019-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "21076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T53518",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF SC",
            "identifier": "134323946",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

Verify at the official NPI Registry.