NPIMap

Individual provider Active NPI

Anthony Aden Ombogo, M.D.

  • Family Medicine Physician
  • Port Orange, FL
National Provider Identifier
1417266024
Registry record updated Jun 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME108702 Issued in FL
Practice address
3911 S Nova Rd
Port Orange, FL 32127-4910
Phone
(386) 756-7748
Fax
(386) 761-5449
NPI assigned
Sep 30, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TRN12964 FL
Family Medicine Physician 207Q00000X 66728 GA
Family Medicine Physician 207Q00000X ME108702 FL Primary

Addresses

Primary practice location

3911 S Nova Rd
Port Orange, FL 32127-4910

Mailing address

303 N Clyde Morris Blvd
Daytona Beach, FL 32114-2709
Phone (386) 756-7748

Other identifiers 1

IdentifierTypeStateIssuer
003112054AMedicaidGA

Other names 1

  • Anthony Obiero Ombogo Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20110926000578 FL Practitioner - Family PracticePractitioner - Hospitalist 1254502123 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospitalist
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

86 W Underwood St
Orlando, FL 32806-1110
Phone (407) 896-1100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TRN12964FLMDFamily Medicine Physician
66728GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Oct 1, 2021 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Oct 1, 2021 Accepting new patients
Orlando Health, Inc. Current Accepting new patients
Halifax Healthcare Systems Inc Family Medicine CurrentSince Apr 13, 2014 Accepting new patients

Locations

201 N Clyde Morris Blvd
Ste 240
Daytona Beach, FL 32114
Phone (386) 258-4934

303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

86 Underwood St
Orlando, FL 32806
Phone (321) 841-5142

1414 Kuhl Ave
#38
Orlando, FL 32806
Phone (407) 481-7179

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: aombogo312890@orlandohealth.medalliesdirect.net
  • FHIR API: https://fhir4.healow.com/fhir/r4/FEHHBA/Endpoint/FEHHBA

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1285804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1417266024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142709",
            "telephone_number": "386-756-7748",
            "fax_number": "386-761-5449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3911 S NOVA RD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274910",
            "telephone_number": "386-756-7748",
            "fax_number": "386-761-5449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMBOGO",
        "first_name": "ANTHONY",
        "middle_name": "ADEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-30",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "TRN12964",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "66728",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME108702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003112054A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANTHONY",
            "last_name": "OMBOGO",
            "middle_name": "OBIERO",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port Orange, FL

Sources for this page

Verify at the official NPI Registry.