Active NPI
Damian Okpako Idjagboro, PA-C
- Physician Assistant
- Houston, TX
National Provider Identifier
1982635876
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Feb 20, 2020.
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA03357
- Practice address
- 8449 W Bellfort St
Sutie 245
Houston, TX 77071-2245 - Phone
- (832) 366-5980
- Fax
- (713) 900-6807
- NPI assigned
- Jul 6, 2006
- Last updated
- Aug 13, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA03357 | TX | Primary |
Addresses
Primary practice location
8449 W Bellfort St
Sutie 245
Houston, TX 77071-2245
Mailing address
PO Box 1950
Sugar Land, TX 77487-1950
Phone (956) 536-1403
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA03357 | TX | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David C Champion MD PA | Past | Accepting new patients |
Organizations & group practices 5
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.
-
- Primary Care Clinic/Center
- Houston, TX
- NPI 1912061276
-
- Primary Care Clinic/Center
- Harlingen, TX
- NPI 1184630402
-
- Physician Assistant
- Houston, TX
- NPI 1326328592
-
- Mental Health Counselor
- Richmond, TX
- NPI 1386067296
-
- Family Medicine Physician
- Brownsville, TX
- NPI 1407881188
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376352000000",
"number": "1982635876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1950",
"city": "SUGAR LAND",
"state": "TX",
"postal_code": "774871950",
"telephone_number": "956-536-1403",
"fax_number": "956-361-4539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8449 W BELLFORT ST",
"address_2": "SUTIE 245",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770712245",
"telephone_number": "832-366-5980",
"fax_number": "713-900-6807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IDJAGBORO",
"first_name": "DAMIAN",
"middle_name": "OKPAKO",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-06",
"last_updated": "2013-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA03357",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.