NPIMap

Individual provider Active NPI

Chukwudi E. Ogbolu, MD

  • Internal Medicine Physician
  • East Stroudsburg, PA
National Provider Identifier
1629038468
Registry record updated Mar 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD421052 Issued in PA
Practice address
704 Brushy Mountain Rd
East Stroudsburg, PA 18301-9349
Phone
(610) 533-3457
Fax
(570) 805-2218
NPI assigned
Mar 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 3, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD421052 PA Primary

Addresses

Primary practice location

704 Brushy Mountain Rd
East Stroudsburg, PA 18301-9349

Mailing address

704 Brushy Mountain Rd
East Stroudsburg, PA 18301-9349
Phone (610) 533-3457

Other identifiers 1

IdentifierTypeStateIssuer
0019475840005MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20050419001108 PA Practitioner - Internal Medicine 2163460304 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Morehouse School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pennsylvania HM Associates, PCGroup PAC ID 0547404337, 31 clinicians

Practice addresses (Care Compare)

206 E Brown St
Pocono Medical Center
East Stroudsburg, PA 18301-3094
Phone (570) 421-4000

Hospital & facility affiliations

  • Lehigh Valley Home Care Home health agency, Allentown, PA, CCN 397023
  • Lehigh Valley Hospital - Pocono Hospital, East Stroudsburg, PA, CCN 390201
  • Lehigh Valley Hospital Hospital, Allentown, PA, CCN 390133
  • Lehigh Valley Hospital - Pocono Inpatient rehabilitation facility, East Stroudsburg, PA, CCN 39T201
  • Whitestone Care Center Nursing home, Stroudsburg, PA, CCN 396130

Merit-based Incentive Payment System (MIPS)

Final score
97.74 of 100Reported as individual
Quality
93.8
Improvement activities
40
Cost
79.98

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pennsylvania HM Associates PC CurrentSince Aug 1, 2013 Accepting new patients
Eac Medical Services, LLC CurrentSince Jun 1, 2015 Accepting new patients
Whitestone Healthcare Group, LLC Past Accepting new patients
Lehigh Valley Hospital Pocono Past Accepting new patients

Locations

206 E Brown St
East Stroudsburg, PA 18301
Phone (570) 420-4951

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15597/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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.

Hospital & facility affiliations 9

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": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488499200000",
    "number": "1629038468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 BRUSHY MOUNTAIN RD",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183019349",
            "telephone_number": "610-533-3457",
            "fax_number": "570-805-2218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 BRUSHY MOUNTAIN RD",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183019349",
            "telephone_number": "610-533-3457",
            "fax_number": "570-805-2218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGBOLU",
        "first_name": "CHUKWUDI",
        "middle_name": "E.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2017-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD421052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019475840005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Stroudsburg, PA

Sources for this page

Verify at the official NPI Registry.