Roseline Oghomwen Shofolu

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

555 Stockton St
Jacksonville, FL 32204-2534

Phone

(904) 387-4661

NPI assigned

Aug 1, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Rehabilitation Center IncGroup PAC ID 0648371716, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Community Rehabilitation Center Inc

  • Point of Service
  • Jacksonville, FL
  • NPI 1528165909
  Medicare reassignment Care Compare group NPD
• Community Rehabilitation Center, Inc.

  • Community/Behavioral Health Agency
  • Jacksonville, FL
  • NPI 1770868010
  NPD

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

{
    "created_epoch": "1564617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564617600000",
    "number": "1891349320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 STOCKTON ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322042534",
            "telephone_number": "904-387-4661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 STOCKTON ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322042534",
            "telephone_number": "904-387-4661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOFOLU",
        "first_name": "ROSELINE",
        "middle_name": "OGHOMWEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-01",
        "last_updated": "2019-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather M. Shockley, MA
• Jada Rene Shockley, PA-C
• Alexandra Judith Shoemaker, PA-C
• Amanda Lee Shoemaker, PA-C
• Mary Lynnette Shoffner
• Payal Paresh Patel Shooliz, MD
• Pouya Shooliz, M.D.
• Stanvonna Shootes
• Remington Shopa
• Shopjveon LLC

• Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; 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.
• 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.