Martha Kerubo Ombogo

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

2022012281 Issued in MO

Practice address

12272 Creve Coeur Ridge CT
Maryland Heights, MO 63043-1213

Phone

(816) 824-1447

NPI assigned

Apr 6, 2022

Sex

Female

Sole proprietor

No

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 MO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  MO

  Medicare reassignment NPD

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

{
    "created_epoch": "1649203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1871234435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12272 CREVE COEUR RIDGE CT",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630431213",
            "telephone_number": "816-824-1447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12272 CREVE COEUR RIDGE CT",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630431213",
            "telephone_number": "816-824-1447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMBOGO",
        "first_name": "MARTHA",
        "middle_name": "KERUBO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-06",
        "last_updated": "2022-04-06",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2022012281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NHC Healthcare-Maryland Heights LLC
• Nitas Care Services LLC
• Occupational Health Centers of Kansas PA (Concentra Medical Center)
• Occupational Health Centers of Kansas PA (Concentra Medical Center)
• Abigail Ohlms, CCC-SLP
• Margaret J Oney, PNP
• Optum Behavioral Care of Ohio, Inc.
• Optum Palliative and Hospice Care, Inc.
• Our Urgent Care, LLC
• Caleb Owsley, MD

• Gerontology Nurse Practitioner in Maryland Heights, MO
• Providers in Maryland Heights, MO by specialty
• Gerontology Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; 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.