Individual provider Active NPI

Obiageli U Obi

  • Pediatric Endocrinology Physician
  • Jackson, MS
National Provider Identifier
1578950796
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
License
27999 Issued in MS
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(601) 815-2005
NPI assigned
Apr 26, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology Physician 2080P0205X 27999 MS Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

504 Clinton Center Drive
Cbo-Suite 4300
Clinton, MS 39056-5601
Phone (601) 815-2005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201130001678 MS Practitioner - Pediatric MedicinePractitioner - Endocrinology 7214208792 Reassigns benefits to 1 organization
I20240723002448 WA Practitioner - Pediatric Medicine 7214208792 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Jul 15, 2024 Accepting new patients
Multicare Health System CurrentSince Jul 15, 2024 Accepting new patients
Multicare Health System Current Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Oct 10, 2020 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Oct 10, 2020 Accepting new patients
Multicare Health Systems Past Accepting new patients
Multicare Health System Past Accepting new patients

Locations

504 Clinton Center Dr
Ste 4300
Clinton, MS 39056

2500 N State St
Ste 4200
Jackson, MS 39216

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

17700 SE 272nd St
Ste 460
Covington, WA 98042
Phone (253) 403-0077

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

17700 SE 272nd St
#460
Kent, WA 98042

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

200 Lilly Rd NE
Ste C
Olympia, WA 98506
Phone (360) 918-8336

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1430006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1578950796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 CLINTON CENTER DRIVE",
            "address_2": "CBO-SUITE 4300",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390565601",
            "telephone_number": "601-815-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBI",
        "first_name": "OBIAGELI",
        "middle_name": "U",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-26",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "MS",
            "license": "27999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.