Omni Clinic PA

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

9901455 Issued in NC

Legal business name

OMNI CLINIC PA

Practice address

22 Office Park Dr
Jacksonville, NC 28546-7325

Phone

(910) 219-4070

Fax

(910) 219-4071

NPI assigned

Apr 10, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Teresa Burkett

Title

Office Supervisor

Phone

(910) 219-4070

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ibikunle Adeola Ojebuoboh, M.D.

  • Internal Medicine Physician
  • Jacksonville, NC
  • NPI 1093778276
  Medicare reassignment NPD

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408406400000",
    "number": "1790748960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12353",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285462353",
            "telephone_number": "910-219-4070",
            "fax_number": "910-219-4071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 OFFICE PARK DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467325",
            "telephone_number": "910-219-4070",
            "fax_number": "910-219-4071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2014-08-19",
        "status": "A",
        "authorized_official_last_name": "BURKETT",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "OFFICE SUPERVISOR",
        "authorized_official_telephone_number": "910-219-4070",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NC",
            "license": "9901455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5909266",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ibikunle Adeola Ojebuoboh, M.D.
• Old North State Medical Foundation
• Erika Oldham, LCSW, LCAS, CSI
• Arnold Camacho Olegario, M.D.
• Joshyra Oliver, LCMHCA
• One Step Transitional Home Ministry, Inc
• Jenna Leigh Onofrio, RN
• Onslow Ambulatory Services, Inc
• Onslow Ambulatory Services, Inc
• Onslow Ambulatory Services, Inc

• Exclusive Provider Organization in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Exclusive Provider Organization in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.