NPIMap

Individual provider Active NPI

Omolara Otaigbe, MD

  • Family Medicine Physician
  • Hattiesburg, MS
National Provider Identifier
1932164456
Registry record updated Dec 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17878 Issued in MS
Practice address
6600 U S Highway 98
Suite B
Hattiesburg, MS 39402-8441
Phone
(601) 261-2727
Fax
(601) 261-9847
NPI assigned
Apr 18, 2006
Last updated
Dec 12, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17878 MS Primary

Addresses

Primary practice location

6600 U S Highway 98
Suite B
Hattiesburg, MS 39402-8441

Mailing address

6600 U S Highway 98
Suite B
Hattiesburg, MS 39402-8441
Phone (601) 261-2727

Other identifiers 1

IdentifierTypeStateIssuer
00126731MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080219000535 MS Practitioner - Family Practice 8224112917 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6600 U S Hwy 98
Suite B
Hattiesburg, MS 39402-8441
Phone (601) 261-2727

6600 US Hwy 98
Suite B
Hattiesburg, MS 39402-8441

6600 US Hwy 98 B
Hattiesburg, MS 39402-8441

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
17878MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Otaigbe Southern Medical Care, PLLC Family Medicine CurrentSince May 1, 2014 Accepting new patients
Teladoc Health Medical Group, P.a. Family Medicine CurrentSince Mar 17, 2021 Accepting new patients
Bedford Care Center-Monroe Hall, LLC Past Accepting new patients
Southern Medical Care Family Medicine Past Accepting new patients
Bedford Alzheimers Care Center, LLC Past Accepting new patients
Pacific Physician Services LLC Past Accepting new patients

Locations

6600 U S Highway 98
#B
Hattiesburg, MS 39402
Phone (601) 261-2727

1945 Lakepointe Dr
Lewisville, TX 75057
Phone (214) 302-5246

Interoperability endpoints

  • Direct secure messaging: omolaraotaigbe@smc.nablemd.direct-ci.com
  • Direct secure messaging: omolaraotaigbe@tdh.allscriptsdirect.net

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418342400000",
    "number": "1932164456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 U S HIGHWAY 98",
            "address_2": "SUITE B",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028441",
            "telephone_number": "601-261-2727",
            "fax_number": "601-261-9847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 U S HIGHWAY 98",
            "address_2": "SUITE B",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028441",
            "telephone_number": "601-261-2727",
            "fax_number": "601-261-9847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTAIGBE",
        "first_name": "OMOLARA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-18",
        "last_updated": "2014-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "17878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00126731",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.