Organization Active NPI

Emmanuel K Onwutuebe a Professional Corporation

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1467518829
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
10254 Issued in NV
Legal business name
EMMANUEL K ONWUTUEBE A PROFESSIONAL CORPORATION
Practice address
6970 W. Patrick Lane
Suite 140
Las Vegas, NV 89113-0270
Phone
(702) 450-1717
Fax
(702) 947-6740
NPI assigned
Dec 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Authorized official

Name
Emmanuel K Onwutuebe, MDNPI 1447224431
Title
Medical Doctor
Phone
(702) 909-3300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 10254 NV Primary

Addresses

Primary practice location

6970 W. Patrick Lane
Suite 140
Las Vegas, NV 89113-0270

Mailing address

6970 W. Patrick Lane
Suite 140
Las Vegas, NV 89113-0270
Phone (702) 450-1717

Other identifiers 1

IdentifierTypeStateIssuer
002018728MedicaidNV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070319000000 NV Part B Supplier - Clinic/Group Practice 4789787441 Receives reassigned benefits from 1 practitioner
Practice locations: Las Vegas, NV; North Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

3860 W Ann Rd
Ste 110
North Las Vegas, NV 89031
Phone (702) 909-3300

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576540800000",
    "number": "1467518829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6970 W. PATRICK LANE",
            "address_2": "SUITE 140",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891130270",
            "telephone_number": "702-450-1717",
            "fax_number": "702-947-6740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6970 W. PATRICK LANE",
            "address_2": "SUITE 140",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891130270",
            "telephone_number": "702-450-1717",
            "fax_number": "702-947-6740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMMANUEL K ONWUTUEBE A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A",
        "authorized_official_last_name": "ONWUTUEBE",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "702-909-3300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "10254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002018728",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.