NPIMap

Individual provider Active NPI

Oluwaseun Omole, APRN

  • Family Nurse Practitioner
  • Chandler, AZ
National Provider Identifier
1497339220
Registry record updated Mar 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
272897 Issued in AZ
Practice address
1915 E Chandler Blvd Ste 1
Chandler, AZ 85225-5117
Phone
(623) 335-2390
NPI assigned
May 7, 2021
Last updated
Mar 24, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 272897 AZ Primary
Registered Nurse 163W00000X RN183690 AZ

Addresses

Primary practice location

1915 E Chandler Blvd Ste 1
Chandler, AZ 85225-5117

Mailing address

1915 E Chandler Blvd Ste 1
Chandler, AZ 85225-5117
Phone (623) 335-2390

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20220414001605 AZ Practitioner - Nurse Practitioner 9436545647 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pioneer Hospitalists, PLLCGroup PAC ID 0941290290, 50 clinicians

Practice addresses (Care Compare)

475 S Dobson Rd
Chandler, AZ 85224-5605
Phone (888) 488-7640

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN183690AZMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Hospitalists, PLLC CurrentSince Aug 3, 2023 Accepting new patients
Leading Health Managed Care, LLC CurrentSince May 1, 2022 Accepting new patients
Pain and Palliative Associates of Arizona CurrentSince Feb 1, 2023 Accepting new patients

Locations

3100 W Ray Rd
Ste 201
Chandler, AZ 85226
Phone (269) 312-1446

9130 E Elliot Rd
Mesa, AZ 85212
Phone (480) 410-4500

4202 N 20th Ave
Phoenix, AZ 85015
Phone (602) 264-3824

Organizations & group practices 3

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 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1620345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648080000000",
    "number": "1497339220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 E CHANDLER BLVD STE 1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852255117",
            "telephone_number": "623-335-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 E CHANDLER BLVD STE 1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852255117",
            "telephone_number": "623-335-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMOLE",
        "first_name": "OLUWASEUN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-07",
        "last_updated": "2022-03-24",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "272897",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN183690",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

Verify at the official NPI Registry.