Individual provider Active NPI

Ilevba Uwaila Osarenkhoe, MD

  • Pediatrics Physician
  • Clinton, MD
National Provider Identifier
1992978910
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0067100 Issued in MD
Practice address
7503 Surratts Rd
Clinton, MD 20735-3358
Phone
(301) 868-8000
NPI assigned
Apr 10, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 255678 MA
Pediatrics Physician 208000000X D0067100 MD Primary

Addresses

Primary practice location

7503 Surratts Rd
Clinton, MD 20735-3358

Mailing address

7503 Surratts Rd
Clinton, MD 20735-3358
Phone (301) 868-8000

Other practice location 1

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

Other identifiers 1

IdentifierTypeStateIssuer
110097583AMedicaidMA

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Direct Messaging Address iosarenkhoe129168@UmassMemorial.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, VA, DC, ID, TX5 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
I20080814000065 MD Practitioner - HospitalistPractitioner - Pediatric Medicine 0345315115 Reassigns benefits to 4 organizations
I20120206000353 VA Practitioner - HospitalistPractitioner - Pediatric Medicine 0345315115 Reassigns benefits to 2 organizations
I20120906000705 DC Practitioner - Pediatric Medicine 0345315115 Reassigns benefits to 4 organizations
I20140626002424 ID Practitioner - Pediatric Medicine 0345315115 Reassigns benefits to 1 organization
I20210510002229 TX Practitioner - General Practice 0345315115 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0067100MDMDPediatrics Physician
106361MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital CurrentSince Sep 27, 2019 Accepting new patients
Medstar Medical Group II LLC CurrentSince May 1, 2025 Accepting new patients
Medstar Medical Group II LLC CurrentSince Jun 9, 2016 Accepting new patients
Vpa of Texas PLLC CurrentSince Apr 1, 2021 Accepting new patients
Medstar Medical Group II LLC CurrentSince May 1, 2025 Accepting new patients
MGMC LLC CurrentSince Jun 9, 2016 Accepting new patients
Children'S Hospital Current Accepting new patients
Vpa of Texas PLLC Pediatrics CurrentSince Apr 1, 2021 Accepting new patients
Children'S Hospital Pediatrics CurrentSince Sep 27, 2019 Accepting new patients
Mdics at Calvert LLC CurrentSince Aug 24, 2021 Accepting new patients
Emergency Medicine Associates, P.a.,P.C. CurrentSince Feb 1, 2016 Accepting new patients
Vpa of Texas PLLC Current Accepting new patients
Signify Health, LLC CurrentSince Apr 1, 2021 Accepting new patients
MGMC, LLC CurrentSince Jun 9, 2016 Accepting new patients
PM Pediatrics of Delaware PA Pediatrics Past Accepting new patients
PM Pediatrics of New England LLC Pediatrics Past Accepting new patients
Medstar Southern Maryland Hospital Center Inc Past Accepting new patients

Locations

3800 Reservoir Rd NW
Washington, DC 20007
Phone (202) 687-2203

1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401

111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670

950 W Bannock St
Ste 1100
Boise, ID 83702
Phone (201) 293-7689

29955 Three Notch Rd
Ste 100
Charlotte Hall, MD 20622
Phone (301) 290-5300

7503 Surratts Rd
Clinton, MD 20735
Phone (301) 868-8000

1406 Crain Hwy S
Glen Burnie, MD 21061
Phone (410) 768-6440

25500 Point Lookout Rd
Leonardtown, MD 20650
Phone (301) 475-6106

100 Hospital Rd
Prnc Frederck, MD 20678
Phone (410) 414-4791

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

4545 Fuller Dr
Ste 325
Irving, TX 75038
Phone (972) 870-5511

1701 N George Mason Dr
Arlington, VA 22205
Phone (703) 558-5000

1001 Sam Perry Blvd
Fredericksburg, VA 22401
Phone (540) 741-1100

15225 Heathcote Blvd
Haymarket, VA 20169
Phone (571) 284-1000

1850 Town Center Pkwy
Reston, VA 20190
Phone (703) 478-0922

1806 Summit Ave
Richmond, VA 23230
Phone (213) 433-2823

Interoperability endpoints

  • Direct secure messaging: iosarenkhoe49437@direct.southcoast.org
  • Direct secure messaging: iosarenkhoe129168@umassmemorial.direct-ci.com

Organizations & group practices 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1992978910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7503 SURRATTS RD",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353358",
            "telephone_number": "301-868-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7503 SURRATTS RD",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353358",
            "telephone_number": "301-868-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Longwood Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021155724",
            "country_code": "US",
            "telephone_number": "617-355-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OSARENKHOE",
        "first_name": "ILEVBA",
        "middle_name": "UWAILA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-10",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "255678",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0067100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110097583A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "60 Hospital Rd",
            "city": "Leominster",
            "state": "MA",
            "country_code": "US",
            "postal_code": "014532205",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iosarenkhoe129168@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "60 Hospital Rd",
            "city": "Leominster",
            "state": "MA",
            "country_code": "US",
            "postal_code": "014532205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clinton, MD

Sources for this page

Verify at the official NPI Registry.