Organization Active NPI

Dr Albert Obiozo Pediatrics Inc

  • Pediatrics Physician
  • El Dorado, AR
National Provider Identifier
1417461500
Registry record updated Sep 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
E-7665 Issued in AR
Legal business name
DR ALBERT OBIOZO PEDIATRICS INC
Practice address
615 Thompson Ave
El Dorado, AR 71730-4557
Phone
(870) 444-5147
Fax
(870) 444-5129
NPI assigned
Nov 28, 2017
Last updated
Sep 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2026

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

Authorized official

Name
Mr. Habib Khan
Title
Manager
Phone
(214) 644-7296

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E-7665 AR Primary

Addresses

Primary practice location

615 Thompson Ave
El Dorado, AR 71730-4557

Mailing address

615 Thompson Ave
El Dorado, AR 71730-4557
Phone (870) 444-5147

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180103001485 AR Part B Supplier - Clinic/Group Practice 2365700911 Receives reassigned benefits from 1 practitioner
Practice locations: El Dorado, AR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2149288Albert Obiozo Pediatrics Inc615 Thompson Ave, El Dorado, AR 71730Certificate of waiverMay 29, 2028

National Provider Directory

National Provider Directory

Locations

514 E 5th St
El Dorado, AR 71730
Phone (848) 228-6579

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1511827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788998400000",
    "number": "1417461500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 THOMPSON AVE",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717304557",
            "telephone_number": "870-444-5147",
            "fax_number": "870-444-5129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 THOMPSON AVE",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717304557",
            "telephone_number": "870-444-5147",
            "fax_number": "870-444-5129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR ALBERT OBIOZO PEDIATRICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-28",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "HABIB",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "214-644-7296",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-7665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Dorado, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.