Individual provider Active NPI

Vincent Odenigbo, MD

  • Anesthesiology Physician
  • Philadelphia, PA
National Provider Identifier
1356331045
Registry record updated Nov 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD420601 Issued in PA
Practice address
111 S 11TH St Ste G8490
Philadelphia, PA 19107
Phone
(215) 955-1120
NPI assigned
Oct 25, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD420601 PA Primary

Addresses

Primary practice location

111 S 11TH St Ste G8490
Philadelphia, PA 19107

Mailing address

111 S 11TH St Ste G8490
Philadelphia, PA 19107-4824
Phone (215) 955-1120

Other practice location 1

900 Walnut St
Philadelphia, PA 19107
Phone (215) 955-6161

Other practice location 2

230 N Broad St
Philadelphia, PA 19102-1121
Phone (215) 762-7922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20041014000691 PA Practitioner - Anesthesiology 7416917364 Reassigns benefits to 1 organization
I20190911003344 NJ Practitioner - Anesthesiology 7416917364

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824
Phone (215) 955-6161

435 Hurffville Cross Keys Rd
Turnersville, NJ 08012-2453
Phone (833) 958-2198

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Anesthesiology CurrentSince Oct 7, 2019 Accepting new patients
North American Partners in Anesthesia of New Jersey LLC Anesthesiology CurrentSince Jul 22, 2019 Accepting new patients
Philadelphia Health & Education Corporation Past Accepting new patients

Locations

1 Clara Maass Dr
Belleville, NJ 07109
Phone (973) 450-2008

300 2nd Ave
Long Branch, NJ 07740
Phone (732) 222-5200

703 Main St
Paterson, NJ 07503
Phone (973) 754-2240

435 Hurffville Cross Keys Rd
Turnersville, NJ 08012
Phone (856) 513-4124

68 S Service Rd
Ste 350
Melville, NY 11747
Phone (516) 945-3107

900 Walnut St
Philadelphia, PA 19107
Phone (215) 503-8080

111 S 11th St
Ste G
Philadelphia, PA 19107
Phone (215) 923-6400

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

111 S 11th St
Ste 8490
Philadelphia, PA 19107
Phone (215) 955-6161

111 S 11th St
Ste G8490
Philadelphia, PA 19107
Phone (215) 955-1120

900 Walnut St
Fl 2
Philadelphia, PA 19107
Phone (215) 955-1234

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.

Hospital & facility affiliations 1

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": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1356331045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST STE G8490",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-1120",
            "fax_number": "215-955-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST STE G8490",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "215-955-1120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Walnut St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19107",
            "country_code": "US",
            "telephone_number": "215-955-6161",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "230 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191021121",
            "country_code": "US",
            "telephone_number": "215-762-7922",
            "fax_number": "215-762-8656",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODENIGBO",
        "first_name": "VINCENT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-25",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD420601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.