Jumoke Fadeke Omisore, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R147715 Issued in MD

Practice address

1529 Winfields LN
Gambrills, MD 21054-1127

Phone

(410) 790-9640

NPI assigned

Aug 20, 2018

Last updated

Dec 13, 2024By the provider in NPPES

Sex

Female

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

Enrolled in MD, DC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valor Health IncGroup PAC ID 6709206337, 5 clinicians

Bon Ridge Wellness LLCGroup PAC ID 1951775337, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jumoke.omisore.1@32712.direct.athenahealth.com

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.

• Bon Ridge Wellness, LLC

  • Clinical Social Worker
  • Windsor Mill, MD
  • NPI 1922710995

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Valor Health Inc

  • Multi-Specialty Clinic/Center
  • Glen Burnie, MD
  • NPI 1427576040
  Medicare reassignment Care Compare group NPD
• Winners Healthcare Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Baltimore, MD
  • NPI 1811596281
  Medicare reassignment Authorized official
• Matclinic Physicians Practice Group LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Dundalk, MD
  • NPI 1104375294

  Multi-Specialty

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  DC, Multi-Specialty

  Medicare reassignment NPD
• Winners Healthcare Services LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Baltimore, MD
  • NPI 1306597810
  NPD (past) Authorized official
• Winners Healthcare Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Baltimore, MD
  • NPI 1336080464

  Multi-Specialty

  NPD (past) Authorized official
• Matclinic Physicians Practice Group LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Laurel, MD
  • NPI 1194217091

  Multi-Specialty

  NPD
• Matclinic Physicians Practice Group LLC

  • Addiction (Substance Use Disorder) Counselor
  • Dundalk, MD
  • NPI 1801448360

  Multi-Specialty

  NPD

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1629558572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1529 WINFIELDS LN",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541127",
            "telephone_number": "410-790-9640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1529 WINFIELDS LN",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541127",
            "telephone_number": "410-790-9640"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1529 Winfields Ln",
            "address_purpose": "LOCATION",
            "city": "Gambrills",
            "state": "MD",
            "postal_code": "210541127",
            "country_code": "US",
            "telephone_number": "410-903-9206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OMISORE",
        "first_name": "JUMOKE",
        "middle_name": "FADEKE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-20",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "RI47715",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R147715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chukwuemeka Victor Nwosu, PHARMD
• Chinedu Nzeli
• Julia Theresa O'Brien, AU.D.
• Oceanblu Healthcare Services LLC
• Rashidat Odeyale, NURSE PRACTITIONER
• Oncall Outpost
• Rachell Roda Flores Oncena
• Kenneth Oseleononmen
• Adeyosola Oludara Oyewale
• Varsha Padmanabhan, D.D.S

• Psychiatric/Mental Health Nurse Practitioner in Gambrills, MD
• Providers in Gambrills, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.