Physician Compare National (NPI:1932164456)

HEALTHCARE PROVIDER: OMOLARA OTAIGBE MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1932164456
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8224112917
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080219000535
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	OTAIGBE
	Individual professional last name
Provider First Name	OMOLARA
	Individual professional first name
Provider Middle Name	Y
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1987
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	6600 U S HWY 98 B
	Group Practice or individual's line 1 address
City	HATTIESBURG
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	394028441
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	250094
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERIT HEALTH WESLEY
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	250078
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	FORREST GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y