Ismaila Kolawole Odubena

Primary specialty

Home Health AideTaxonomy code 374U00000X

Practice address

4651 Pebbleshire CT
Waldorf, MD 20602-4108

Phone

(240) 606-4620

NPI assigned

Apr 5, 2012

Last updated

Sep 20, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Procare

  • Non-emergency Medical Transport (VAN)
  • Capitol Heights, MD
  • NPI 1124448253
  NPD (past) Authorized official

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537401600000",
    "number": "1538425384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 SHAMROCK AVE",
            "city": "CAPITOL HEIGHTS",
            "state": "MD",
            "postal_code": "207435302",
            "telephone_number": "240-606-4620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4651 PEBBLESHIRE CT",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206024108",
            "telephone_number": "240-606-4620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODUBENA",
        "first_name": "ISMAILA",
        "middle_name": "KOLAWOLE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-05",
        "last_updated": "2018-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "DC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frankline Takunaw Oben
• Aruoriwo M Oboh-Weilke, MD
• Mercy Obour, LMSW
• Emily Rosa Odenwald, MSN, WHNP-BC
• Ariarna M Odom, LGPC
• Odyssey Empowered, LLC
• William John Oetgen, M.D.
• Victor Fifie Ofori
• Doris Ogunmakinwa, PMHNP
• Temitope Ogunnaike, PA-C, MHS

• Home Health Aide in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Home Health Aide in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.