Active NPI
Ifeyinwa Ajumobi, PA
- Physician Assistant
- Camp Lejeune, NC
National Provider Identifier
1790224079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601008133
- Practice address
- 100 Brewster Blvd
Camp Lejeune, NC 28547-2575 - Phone
- (910) 450-4840
- NPI assigned
- Feb 20, 2017
- Last updated
- Feb 13, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601008133 | MI | Primary |
Addresses
Primary practice location
100 Brewster Blvd
Camp Lejeune, NC 28547-2575
Mailing address
100 Brewster Blvd
Camp Lejeune, NC 28547-2575
Phone (910) 450-4840
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962808162 | Medicaid | MI |
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601008133 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lansing Urgent Care, PLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Urgent Care Clinic/Center
- Lansing, MI
- NPI 1780987990
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707782400000",
"number": "1790224079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 BREWSTER BLVD",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "285472575",
"telephone_number": "910-450-4840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 BREWSTER BLVD",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "285472575",
"telephone_number": "910-450-4840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AJUMOBI",
"first_name": "IFEYINWA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-20",
"last_updated": "2024-02-13",
"certification_date": "2024-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601008133",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1962808162",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Camp Lejeune, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.