SAMSON AJIBOLA OMOWUMI
NPI 1457181877
Nurse Practitioner - Psychiatric/Mental Health in Peoria, IL
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
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Samson Ajibola Omowumi is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
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.
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.
PEORIA, IL 61614
PEORIA, IL 61614
PEORIA, IL 61614
PEORIA, IL 61614
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.
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.
# Samson Ajibola Omowumi · NPI 1457181877
Psychiatric/Mental Health physician in Peoria, Illinois. Individual provider, active in the CMS NPPES registry since August 2, 2024.
## Identity
- **NPI:** 1457181877 (Entity type: Individual)
- **Enumerated:** August 2, 2024
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 209.030167 (Illinois)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 5401 N KNOXVILLE AVE, Peoria, IL 61614-5098
- **Phone:** (614) 816-7589
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** August 2, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1457181877) · Data from the CMS NPPES public registry.