Individual provider Active NPI

Jide Omosewo, CRNA

  • Certified Registered Nurse Anesthetist
  • Victoria, TX
National Provider Identifier
1881991339
Registry record updated Jul 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
869357 Issued in TX
Practice address
1501 E Mockingbird LN
Suite 101
Victoria, TX 77904-2155
Phone
(361) 573-6291
Fax
(361) 576-2434
NPI assigned
Feb 18, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 0024169214 VA
Certified Registered Nurse Anesthetist 367500000X CRNA1477 AZ
Certified Registered Nurse Anesthetist 367500000X 869357 TX Primary

Addresses

Primary practice location

1501 E Mockingbird LN
Suite 101
Victoria, TX 77904-2155

Mailing address

1501 E Mockingbird LN
Suite 101
Victoria, TX 77904-2155
Phone (361) 573-6291

Other practice location 1

645 E Missouri Ave Ste 300
Phoenix, AZ 85012-1351
Phone (602) 262-8917

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TX, NM, CA, AZ, NC, MN, NE8 enrollments

Enrollment records 8

Enrollment IDStateProvider typePAC IDDetails
I20110512000072 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092991802 Reassigns benefits to 1 organization
I20150224000252 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092991802
I20171106001970 NM Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092991802
I20180503000354 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092991802 Reassigns benefits to 3 organizations
I20180523001718 AZ Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092991802 Reassigns benefits to 1 organization
I20191217002165 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092991802 Reassigns benefits to 1 organization
I20230621002680 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092991802 Reassigns benefits to 1 organization
I20230921000521 NE Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092991802 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Georgetown University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Faith Regional Physician Services LLCGroup PAC ID 5193786168, 194 clinicians
Coachella Valley Anesthesia a Professional CorporationGroup PAC ID 5698131969, 126 clinicians

Practice addresses (Care Compare)

2700 W Norfolk Ave
Faith Regional Health Services
Norfolk, NE 68701-4438
Phone (402) 371-4880

420 34TH St
Bakersfield, CA 93301-2237
Phone (661) 324-4647

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.77 of 100Reported as group
Quality
67.03
Promoting interoperability
96
Improvement activities
40
Cost
72.22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
869357TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Services of San Joaquin, P.C. CurrentSince Mar 17, 2018 Accepting new patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2023 Accepting new patients
Valley Anesthesiology Consultants, Inc. CurrentSince Jul 11, 2020 Accepting new patients
Medstream Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Nov 5, 2019 Accepting new patients
FRSC Anesthesia LLC CurrentSince Sep 9, 2024 Accepting new patients
Coachella Valley Anesthesia a Professional Corporation Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2023 Accepting new patients
Faith Regional Physician Services, LLC CurrentSince Sep 5, 2023 Accepting new patients
Faith Regional Physician Services, LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 5, 2023 Accepting new patients
Valley Regional Anesthesia Associates Inc CurrentSince Feb 7, 2024 Accepting new patients
Southeastern Regional Medical Center Past Accepting new patients
Northeast Nebraska Surgery Center LLC PastSince Mar 1, 2020 Accepting new patients
Southeastern Regional Medical Center Past Accepting new patients

Locations (25 of 30)

5880 S Hospital Dr
Globe, AZ 85501
Phone (928) 402-1217

1500 S Dobson Rd
Ste 101
Mesa, AZ 85202
Phone (480) 306-6098

645 E Missouri Ave
Ste 300
Phoenix, AZ 85012
Phone (602) 262-8917

1850 N Central Ave
Ste 1600
Phoenix, AZ 85004
Phone (602) 744-4760

1601 W Saint Marys Rd
Tucson, AZ 85745
Phone (520) 622-5833

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

2615 Chester Ave
Bakersfield, CA 93301
Phone (661) 381-7545

3001 Sillect Ave
Bakersfield, CA 93308
Phone (661) 316-6000

700 W El Norte Pkwy
Escondido, CA 92026
Phone (760) 738-7830

500 W Hospital Rd
French Camp, CA 95231
Phone (209) 468-6000

2139 E Beechwood Ave
Fresno, CA 93720
Phone (559) 322-6600

6601 White Feather Rd
Joshua Tree, CA 92252
Phone (760) 366-1500

1660 W 3rd St
Los Angeles, CA 90017
Phone (213) 201-0850

145 Trevino Ave
Manteca, CA 95337
Phone (209) 788-8180

1205 E North St
Manteca, CA 95336
Phone (209) 239-8301

1300 Mable Ave
Ste 1
Modesto, CA 95355
Phone (209) 571-1633

44139 Monterey Ave
Ste B
Palm Desert, CA 92260
Phone (760) 773-4411

465 W Putnam Ave
Porterville, CA 93257
Phone (559) 784-8886

2900 Eureka Way
Redding, CA 96001
Phone (530) 225-8700

825 Delbon Ave
Turlock, CA 95382
Phone (209) 664-2744

119 S Locust St
#B
Visalia, CA 93291
Phone (559) 366-7177

4050 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 236-6786

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

300 W 27th St
Lumberton, NC 28358
Phone (910) 671-5000

830 Rockford St
Mount Airy, NC 27030
Phone (336) 719-7000

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 2

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": "1297987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1881991339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 E MOCKINGBIRD LN",
            "address_2": "SUITE 101",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042155",
            "telephone_number": "361-573-6291",
            "fax_number": "361-576-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 E MOCKINGBIRD LN",
            "address_2": "SUITE 101",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042155",
            "telephone_number": "361-573-6291",
            "fax_number": "361-576-2434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "645 E Missouri Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850121351",
            "country_code": "US",
            "telephone_number": "602-262-8917",
            "fax_number": "602-262-8890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OMOSEWO",
        "first_name": "JIDE",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-18",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024169214",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AZ",
            "license": "CRNA1477",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "869357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victoria, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; 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.