Active NPI
Raphael Omodunmiju
- Home Health Registered Nurse
- Saint Paul, MN
National Provider Identifier
1770035784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Registered Nurse
- License
- R 231639-4
- Practice address
- 856 University Ave W
Saint Paul, MN 55104-4807 - Phone
- (651) 665-9795
- Fax
- (651) 665-9796
- NPI assigned
- Oct 26, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Registered Nurse | 163WH0200X | R 231639-4 | MN | Primary |
Addresses
Primary practice location
856 University Ave W
Saint Paul, MN 55104-4807
Mailing address
856 University Ave W
Saint Paul, MN 55104-4807
Phone (651) 665-9795
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 231639-4 | MN | MD | Home Health Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Divine Healthcare Corporation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Home Health Agency
- Saint Paul, MN
- NPI 1326150343
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477440000000",
"number": "1770035784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "856 UNIVERSITY AVE W",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044807",
"telephone_number": "651-665-9795",
"fax_number": "651-665-9796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "856 UNIVERSITY AVE W",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044807",
"telephone_number": "651-665-9795",
"fax_number": "651-665-9796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OMODUNMIJU",
"first_name": "RAPHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-26",
"last_updated": "2016-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "163WH0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Home Health",
"state": "MN",
"license": "R 231639-4",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.