Oluwatosin Grace Omotosho, M.D

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036170232 Issued in IL

Practice address

2734 W 87TH St
Chicago, IL 60652-3937

Phone

(773) 918-4700

Fax

(773) 313-3763

NPI assigned

May 21, 2021

Reactivated

Dec 2, 2022

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

Medicare fee-for-service enrollment

Enrolled in IL

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: oomotosho1042096@direct.trinity-health.org

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.

• PMR Illinois Holding, LLC

  • Specialist
  • Miami Gardens, FL
  • NPI 1770038671

  IL

  Medicare reassignment NPD

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1851966865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2734 W 87TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606523937",
            "telephone_number": "773-918-4700",
            "fax_number": "773-313-3763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2734 W 87TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606523937",
            "telephone_number": "773-918-4700",
            "fax_number": "773-313-3763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMOTOSHO",
        "first_name": "OLUWATOSIN",
        "middle_name": "GRACE",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-21",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "deactivation_date": "2022-11-14",
        "reactivation_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036170232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olasubomi Jimmy Omoleye, MD
• Charity Omoregie
• Todd H Omori, D.D.S.
• Osayama Jacquelyn Omoruyi
• Idris Omosanya, PT, DPT
• Janusz Omyla
• Mariola Omyla
• On Call Medical Services LLC (On Call Pediatrics)
• On Counseling, PLLC (Build Within Counseling)
• On Site Dermatology of Illinois PLLC

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.