Individual provider Active NPI

Emmanuel A. Obafemi-Ajayi, MD

  • Pediatrics Physician
  • Springfield, MO
National Provider Identifier
1376720904
Registry record updated Aug 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2008009981 Issued in MO
Practice address
3231 S National Ave Ste 100
Springfield, MO 65807
Phone
(417) 885-0810
NPI assigned
Jan 25, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2008009981 MO Primary
Pediatrics Physician 208000000X 001292 GA

Addresses

Primary practice location

3231 S National Ave Ste 100
Springfield, MO 65807

Mailing address

3231 S National Ave Ste 100
Springfield, MO 65807-7304
Phone (417) 885-0810

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20080926000602 MO Practitioner - Pediatric Medicine 5395812796 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2008009981MOMDPediatrics Physician
001292GAMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Jun 11, 2010 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jun 11, 2010 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 6, 2018 Accepting new patients
Mercy Hospital Springfield Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1717 S Range Line Rd
Ste B
Joplin, MO 64804
Phone (417) 556-2231

120 Hospital Dr
Ste 350
Lebanon, MO 65536
Phone (417) 533-6729

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

3231 S National Ave
Ste 100
Springfield, MO 65807
Phone (417) 841-0116

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Interoperability endpoints

  • Direct secure messaging: eobafemiajayi3056@directb.mercy.net
  • Direct secure messaging: eobafemiajayi22785@directc.mercy.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1201219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535068800000",
    "number": "1376720904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3231 S NATIONAL AVE STE 100",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658077304",
            "telephone_number": "417-885-0810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3231 S NATIONAL AVE STE 100",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "65807",
            "telephone_number": "417-885-0810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBAFEMI-AJAYI",
        "first_name": "EMMANUEL",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-25",
        "last_updated": "2018-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2008009981",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "001292",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.