Kofoworola Ohiomoba

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

R8067 Issued in TX

Practice address

11714 Wilson Parke Ave Ste 150
Austin, TX 78726-4061

Phone

(512) 346-6611

Fax

(512) 406-6267

NPI assigned

Apr 6, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kohiomoba34181@arcmd.direct-ci.com

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.

• Austin Regional Clinic, PA

  • Family Medicine Physician
  • Austin, TX
  • NPI 1821157579

  Pediatrics

  Medicare reassignment NPD
• Austin Regional Clinic, PA

  • Durable Medical Equipment & Medical Supplies
  • Kyle, TX
  • NPI 1235746413
  NPD

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

{
    "created_epoch": "1270512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1700101359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 E HWY 290",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787231142",
            "telephone_number": "512-483-9596",
            "fax_number": "512-406-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11714 WILSON PARKE AVE STE 150",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787264061",
            "telephone_number": "512-346-6611",
            "fax_number": "512-406-6267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OHIOMOBA",
        "first_name": "KOFOWOROLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-06",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "R8067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kofoworola.ohiomoba.p1@direct.lscctx.nextgenshare.com",
            "affiliation": "N",
            "address_1": "200 Nola Ruth Blvd",
            "city": "Harker Heights",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765486074",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kofoworola.ohiomoba.p1@direct.lscctx.nextgenshare.com",
            "affiliation": "N",
            "address_1": "200 Nola Ruth Blvd",
            "city": "Harker Heights",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765486074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shea Oharrow, D.C.
• Benjamin Oheim, AGCNS-BC
• Chelsea Oheim, APRN, CPNP-PC
• Zachary Aaron Oheim, LCSW
• Benjamin Ohene
• Raymond Jude Ohler III, MD
• Anna Janell Ohm
• Sarah Elizabeth Ohn, DDS
• Macaulay Aigbe Ojeaga Jr., MD
• Eric Ojeda

• Pediatrics Physician in Austin, TX
• Providers in Austin, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.