Active NPI
Osiyemi O Osinowo, MD
- Nephrology Physician
- Tyler, TX
National Provider Identifier
1962765024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- R7840
- Practice address
- 1133 Medical Dr
Tyler, TX 75701-2130 - Phone
- (903) 595-5486
- Fax
- (903) 595-5128
- NPI assigned
- Jun 22, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 48247 | KY | |
| Hospitalist Physician | 208M00000X | 48247 | KY | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Nephrology Physician | 207RN0300X | R7840 | TX | Primary |
Addresses
Primary practice location
1133 Medical Dr
Tyler, TX 75701-2130
Mailing address
1133 Medical Dr
Tyler, TX 75701-2130
Phone (903) 595-5486
Other practice location 1
1540 Spring Valley Dr
Huntington, WV 25704-9300
Phone (304) 429-6741
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 387463801 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48247 | KY | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580169600000",
"number": "1962765024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1133 MEDICAL DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757012130",
"telephone_number": "903-595-5486",
"fax_number": "903-595-5128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1133 MEDICAL DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757012130",
"telephone_number": "903-595-5486",
"fax_number": "903-595-5128"
}
],
"practiceLocations": [
{
"address_1": "1540 Spring Valley Dr",
"address_purpose": "LOCATION",
"city": "Huntington",
"state": "WV",
"postal_code": "257049300",
"country_code": "US",
"telephone_number": "304-429-6741",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OSINOWO",
"first_name": "OSIYEMI",
"middle_name": "O",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-22",
"last_updated": "2020-01-28",
"certification_date": "2020-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "KY",
"license": "48247",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "KY",
"license": "48247",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "TX",
"license": "R7840",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "387463801",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.