KOFOWOROLA OHIOMOBA
NPI 1700101359
Pediatrics in Austin, TX

Q: What is Kofoworola Ohiomoba's NPI number?

The NPI number for Kofoworola Ohiomoba is 1700101359. It was assigned to this individual provider in the NPPES registry on April 6, 2010.

Q: What is Kofoworola Ohiomoba's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Active since April 06, 2010PECOS Enrolled

11714 WILSON PARKE AVE STE 150, AUSTIN, TX 78726(512) 346-6611(512) 406-6267 Get Directions Write a Review

NPPES record last updated: January 22, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 8, 2021, May 16, 2019, Nov 7, 2018 and 1 more (4 updates tracked since 2018).

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About Kofoworola Ohiomoba NPPES

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

KOFOWOROLA OHIOMOBA (NPI 1700101359) is an individual pediatrics provider in Austin, Texas, licensed in Texas (R8067) and active in the NPI registry since April 2010. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1700101359

Entity TypeIndividualFemale

Primary Taxonomy208000000X

Provider Legal NameKOFOWOROLA OHIOMOBA

Location Address11714 WILSON PARKE AVE STE 150Austin, TX 78726-4061

Mailing Address6210 E Hwy 290Austin, TX 78723-1142 · (512) 483-9596 · Fax (512) 406-6216

Phone(512) 346-6611

Fax(512) 406-6267

Sole ProprietorYes

Enumeration DateApril 6, 2010

Last NPPES UpdateJanuary 22, 20244 updates tracked since enumeration

NPPES CertifiedJanuary 22, 2024

✔ NPI 1700101359 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in TX · R8067

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

11714 WILSON PARKE AVE STE 150, Austin, TX 78726

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kofoworola Ohiomoba 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 Kofoworola Ohiomoba reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Austin Regional Clinic, PA

11 mi

Family Medicine

6210 E US HWY 290, SUITE 420 - CREDENTIALING
Austin, TX 78723

Reassigned Medicare billing, Texas enrollment
461 clinicians in this Medicare group

NPI 1821157579 (512) 231-5516

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 78726 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

$89.03 typical visit price

range $57.88 – $174.00

Typical copayment $22.25 (range $14.47 – $43.50)

Most-billed visit code 99203

Established Patient

$101.65 typical visit price

range $18.88 – $142.23

Typical copayment $25.41 (range $4.72 – $35.55)

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.

POLLY A RETZ RN, CPNP

Nurse Practitioner