NPIMap

Individual provider Active NPI

Osahon John Obakpolor, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Pittsburgh, PA
National Provider Identifier
1477849628
Registry record updated Jan 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
U3970 Issued in TX
Practice address
4727 Friendship Ave Ste 200
Pittsburgh, PA 15224-1778
Phone
(412) 235-5810
Fax
(412) 235-5890
NPI assigned
Jun 27, 2011
Last updated
Jan 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD452334 PA
Family Medicine Physician 207Q00000X U3970 TX
Geriatric Medicine (Family Medicine) Physician 207QG0300X MD452334 PA
Geriatric Medicine (Family Medicine) Physician 207QG0300X U3970 TX Primary

Addresses

Primary practice location

4727 Friendship Ave Ste 200
Pittsburgh, PA 15224-1778

Mailing address

4727 Friendship Ave Ste 200
Pittsburgh, PA 15224-1778
Phone (412) 235-5810

Other identifiers 2

IdentifierTypeStateIssuer
103054062MedicaidPA
13593382OtherCAQH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address oobakpolor66727@direct.ahn.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20230829003779 TX Practitioner - Family Practice 0840504858 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trumen Physician and Associates Post Acute PLLCGroup PAC ID 5496236788, 127 clinicians
Trumen Physicians and Associates PLLCGroup PAC ID 7618006883, 133 clinicians

Practice addresses (Care Compare)

2626 S Loop W
Suite 265
Houston, TX 77054-5636
Phone (713) 796-9955

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD452334PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Allegheny Clinic Family Medicine Current Accepting new patients
Trumen Physicians and Associates PLLC CurrentSince Aug 15, 2023 Accepting new patients
Oakbend Medical Center Past Accepting new patients
Kruse Village, LLC Past Accepting new patients
South Limestone Hospital District Past Accepting new patients

Locations

2626 S Loop W
Ste 265
Houston, TX 77054
Phone (713) 796-9955

7887 Cambridge St
Houston, TX 77054
Phone (713) 796-2777

Interoperability endpoints

  • Direct secure messaging: oobakpolor66727@direct.ahn.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Brenham Nursing and Rehabilitation CenterBrenham, TX, CCN 675799 Skilled nursing facility Adp of the SNF Jan 1, 2025
Kruse Village Senior Living CommunityBrenham, TX, CCN 675837 Skilled nursing facility Adp of the SNF Aug 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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 10

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": "1309132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1477849628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4727 FRIENDSHIP AVE STE 200",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152241778",
            "telephone_number": "412-235-5810",
            "fax_number": "412-235-5890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4727 FRIENDSHIP AVE STE 200",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152241778",
            "telephone_number": "412-235-5810",
            "fax_number": "412-235-5890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBAKPOLOR",
        "first_name": "OSAHON",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-27",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD452334",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "U3970",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "PA",
            "license": "MD452334",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "U3970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103054062",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13593382",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "oobakpolor66727@direct.ahn.org",
            "affiliation": "N",
            "address_1": "4727 Friendship Ave",
            "address_2": "Suite 200",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152241779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pittsburgh, PA

Sources for this page

Verify at the official NPI Registry.