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SAMSON AJIBOLA OMOWUMI
NPI 1457181877
Nurse Practitioner - Psychiatric/Mental Health in Peoria, IL

Active since August 02, 2024PECOS Enrolled
5401 N KNOXVILLE AVE, PEORIA, IL 61614(614) 816-7589 Get Directions Write a Review

NPPES record last updated: August 2, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Samson Ajibola Omowumi NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMSON AJIBOLA OMOWUMI (NPI 1457181877) is an individual psychiatric/mental health provider in Peoria, Illinois, licensed in Illinois (209.030167) and active in the NPI registry since August 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1457181877
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameSAMSON AJIBOLA OMOWUMI
Location Address5401 N KNOXVILLE AVEPeoria, IL 61614-5098
Mailing Address10830 N Sawmill LnDunlap, IL 61525-7514 · (614) 816-7589
Phone(614) 816-7589
Sole ProprietorYes
Enumeration DateAugust 2, 2024
NPPES CertifiedAugust 2, 2024
✔ NPI 1457181877 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in IL · 209.030167
5401 N KNOXVILLE AVE, Peoria, IL 61614
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samson Ajibola Omowumi is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Samson Omowumi reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Signify Health Medical Associates, PLLC
672 mi
General Practice
4055 VALLEY VIEW LN STE 700
Dallas, TX 75244
  • Reassigned Medicare billing, Illinois enrollment
  • 712 clinicians in this Medicare group
NPI 1750845863 (972) 715-3800

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61614 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COLLIN DAVID ALLEN APN
Student in an Organized Health Care Education/Training Program
5401 N KNOXVILLE AVE
PEORIA, IL 61614
Peoria County (309) 691-1000
YIBING LI MD
Physical Medicine & Rehabilitation
5401 N KNOXVILLE AVE, STE 117
PEORIA, IL 61614
Peoria County (309) 689-8888
PATTI L ALLY
Audiologist-Hearing Aid Fitter
5401 N KNOXVILLE AVE, SUITE 116
PEORIA, IL 61614
Peoria County (309) 282-0887
PROCTOR HEALTH SYSTEMS
Clinic/Center (Medical Specialty)
5401 N KNOXVILLE AVE, SUITE 103
PEORIA, IL 61614
Peoria County (309) 691-7800
MS. BARBARA J NALL APN
Nurse Practitioner (Women's Health)
5401 N KNOXVILLE AVE, SUITE 308
PEORIA, IL 61614
Peoria County (309) 692-5100
SUSAN GWILLIM PT
Physical Therapist
5401 N KNOXVILLE AVE, SUITE 218
PEORIA, IL 61614
Peoria County (309) 693-2244
MR. KEVIN M HENRY MD
Anesthesiology (Pain Medicine)
5401 N KNOXVILLE AVE, SUITE 416
PEORIA, IL 61614
Peoria County (309) 692-7246
MS. COLLEEN SUSANNE CUSHING RAGON APN, CNS
Nurse Practitioner (Family)
5401 N KNOXVILLE AVE
PEORIA, IL 61614
Peoria County (309) 691-1069

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samson Omowumi's NPI number?

The NPI number for Samson Omowumi is 1457181877. It was assigned to this individual provider in the NPPES registry on August 2, 2024.

Where is Samson Omowumi located?

Samson Omowumi practices at 5401 N Knoxville Ave, Peoria, IL 61614. The listed phone number is (614) 816-7589.

What is Samson Omowumi's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Samson Omowumi enrolled in Medicare?

Yes. Samson Omowumi is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Samson Omowumi's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samson Omowumi reassigns Medicare benefits to Signify Health Medical Associates, PLLC (Dallas, TX). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samson Omowumi's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Samson Omowumi was last updated on August 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.