Individual provider Active NPI

Omorowa Obanor, CRNP

  • Family Nurse Practitioner
  • Berwyn, PA
National Provider Identifier
1821539784
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP031434 Issued in PA
Practice address
1001 Chesterbrook Blvd.
Berwyn, PA 19312-3805
Phone
(215) 615-5454
Fax
(215) 349-5534
NPI assigned
Mar 13, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP031434 PA Primary

Addresses

Primary practice location

1001 Chesterbrook Blvd.
Berwyn, PA 19312-3805

Mailing address

3400 Civic Center Blvd
Philadelphia, PA 19104-4238
Phone (215) 615-5454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250303001411 PA Practitioner - Nurse Practitioner 5092236463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

1001 Chesterbrook Blvd
Berwyn, PA 19312-3805
Phone (215) 615-5454

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP031434PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Jan 19, 2025 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group CurrentSince Jan 19, 2025 Accepting new patients

Locations

1001 Chesterbrook Blvd
Berwyn, PA 19312
Phone (610) 576-7500

3400 Convention Ave
Philadelphia, PA 19104
Phone (215) 662-2300

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1489363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1821539784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-615-5454",
            "fax_number": "215-349-5534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 CHESTERBROOK BLVD.",
            "city": "BERWYN",
            "state": "PA",
            "postal_code": "193123805",
            "telephone_number": "215-615-5454",
            "fax_number": "215-349-5534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBANOR",
        "first_name": "OMOROWA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-13",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP031434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, PA

Sources for this page

Verify at the official NPI Registry.