NPIMap

Individual provider Active NPI

John Omozuavbo Oyakhire, M.D.

  • Internal Medicine Physician
  • Augusta, GA
National Provider Identifier
1518051390
Registry record updated Nov 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
102763 Issued in MN
Practice address
1011 River Ridge Dr Apt 24C
Augusta, GA 30909-2238
Phone
(217) 721-1359
NPI assigned
Oct 3, 2006
Last updated
Nov 1, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 1, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 102763 MN Primary
Hospitalist Physician 208M00000X 49205 MN

Addresses

Primary practice location

1011 River Ridge Dr Apt 24C
Augusta, GA 30909-2238

Mailing address

1011 River Ridge Dr Apt 24C
Augusta, GA 30909-2238
Phone (217) 721-1359

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20070426000562 MN Practitioner - HospitalistPractitioner - Internal Medicine 9133127400 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3123

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
102763MNMDInternal Medicine Physician
49205MNMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Family Medicine CurrentSince Dec 14, 2015 Accepting new patients
Park Nicollet Methodist Hospital CurrentSince Dec 14, 2015 Accepting new patients
Park Nicollet Clinic Family Medicine Current Accepting new patients
Banner-University Medical Group Family Medicine Past Accepting new patients
Park Nicollet Methodist Hospital Past Accepting new patients

Locations

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246

Organizations & group practices 5

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509494400000",
    "number": "1518051390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 RIVER RIDGE DR APT 24C",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309092238",
            "telephone_number": "217-721-1359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 RIVER RIDGE DR APT 24C",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309092238",
            "telephone_number": "217-721-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OYAKHIRE",
        "first_name": "JOHN",
        "middle_name": "OMOZUAVBO",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2017-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "102763",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MN",
            "license": "49205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.