NPIMap

Individual provider Active NPI

Onweli Ernest Ogbolu, M.D.

  • Nephrology Physician
  • Suffolk, VA
National Provider Identifier
1336301423
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
318289 Issued in VA
Practice address
3009 Corporate LN Ste 210
Suffolk, VA 23434-9344
Phone
(757) 623-0005
Fax
(757) 935-1561
NPI assigned
Jun 30, 2008
Last updated
Jan 20, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 318289 VA Primary
Internal Medicine Physician 207R00000X 0101253773 VA

Addresses

Primary practice location

3009 Corporate LN Ste 210
Suffolk, VA 23434-9344

Mailing address

4445 Corporation LN Ste 100
Virginia Beach, VA 23462-3666
Phone (757) 623-0005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20130827000516 VA Practitioner - Nephrology 3173766904 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Medical College of Georgia School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tidewater Kidney Specialists IncGroup PAC ID 6507852662, 21 clinicians

Practice addresses (Care Compare)

3009 Corporate LN
Suite 210
Suffolk, VA 23434-9344
Phone (757) 623-0005

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
318289VAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Kidney Specialists, Inc. Nephrology CurrentSince Aug 1, 2013 Accepting new patients
Tidewater Kidney Specialists, Inc. Nephrology CurrentSince Aug 1, 2013 Accepting new patients

Locations

301 Riverview Ave
Ste 512
Norfolk, VA 23510
Phone (757) 627-5116

814 Kempsville Rd
Ste 102
Norfolk, VA 23502

3009 Corporate Ln
Ste 210
Suffolk, VA 23434

4445 Corporation Ln
Ste 100
Virginia Beach, VA 23462

4560 South Blvd
Ste 202
Virginia Beach, VA 23452
Phone (757) 340-6100

Interoperability endpoints

  • Direct secure messaging: onweliogbolu@tks.allscriptsdirect.net

Organizations & group practices 2

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.

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": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1336301423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 CORPORATION LN STE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623666",
            "telephone_number": "757-623-0005",
            "fax_number": "757-548-1129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 CORPORATE LN STE 210",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234349344",
            "telephone_number": "757-623-0005",
            "fax_number": "757-935-1561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGBOLU",
        "first_name": "ONWELI",
        "middle_name": "ERNEST",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": "318289",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101253773",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

Verify at the official NPI Registry.