OMNI CLINIC PA
NPI 1790748960
Exclusive Provider Organization in Jacksonville, NC

Active since April 10, 2006CLIA 34D0981585 · Waiver
22 OFFICE PARK DR, JACKSONVILLE, NC 28546(910) 219-4070(910) 219-4071 Get Directions Write a Review

NPPES record last updated: August 19, 2014. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Omni Clinic Pa NPPES

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

OMNI CLINIC PA (NPI 1790748960) is a healthcare organization registered as an exclusive provider organization in Jacksonville, North Carolina and active in the NPI registry since April 2006. The organization holds a CLIA Waiver certificate valid through January 1, 2027 and lists Teresa Burkett, Office Supervisor, as its authorized official.

NPPES Registry Identity

NPI1790748960
Entity TypeOrganization
Primary Taxonomy302F00000X
Legal Business NameOMNI CLINIC PA
Location Address22 OFFICE PARK DRJacksonville, NC 28546-7325
Mailing AddressPo Box 12353Jacksonville, NC 28546-2353 · (910) 219-4070 · Fax (910) 219-4071
Fax(910) 219-4071
Organization SubpartNo
Authorized OfficialTeresa BurkettOffice Supervisor · (910) 219-4070
Enumeration DateApril 10, 2006
Last NPPES UpdateAugust 19, 2014
✔ NPI 1790748960 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyExclusive Provider OrganizationManaged Care Organizations
Taxonomy Code302F00000X
License✔ Licensed in NC · 9901455
Definition
(1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations.
22 OFFICE PARK DR, Jacksonville, NC 28546

Other Identifiers 3

Medicare PIN2281548B
Medicaid5909266NC
Medicare UPING16642NC

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Omni Clinic Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Omni Clinic PA, which bills Medicare for the services this clinician delivers.

Clinician (1)

Internal Medicine
NPI 1093778276
22 OFFICE PARK DR
Jacksonville, NC 28546
(910) 219-4070
✔ PECOS✔ Accepts MedicareSame address

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D0981585

Omni Clinic PA · Jacksonville, NC
Active · expires Jan 1, 2027
CLIA Number34D0981585
Laboratory TypePhysician Office
Certificate Effective DateJanuary 2, 2025
Certificate Expiration DateJanuary 1, 2027
Laboratory DirectorIbikunle A. Ojebuoboh
Laboratory Phone(910) 219-4070
Laboratory LocationOmni Clinic PA22 Office Park Drive, Jacksonville, NC 28546
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Omni Clinic PA's NPI number?

The NPI number for Omni Clinic PA is 1790748960. It was assigned to this organization in the NPPES registry on April 10, 2006.

Where is Omni Clinic PA located?

Omni Clinic PA is located at 22 Office Park Dr, Jacksonville, NC 28546. The listed phone number is (910) 219-4070.

What is Omni Clinic PA's specialty?

The primary specialty registered for this NPI is Exclusive Provider Organization with taxonomy code 302F00000X.

Is Omni Clinic PA enrolled in Medicare?

Yes. Omni Clinic PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Omni Clinic PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Omni Clinic PA. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Omni Clinic PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D0981585) is associated with this NPI, valid through January 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Omni Clinic PA accept?

Health plans from AmeriHealth Caritas Next and Cigna Healthcare list Omni Clinic PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Omni Clinic PA was last updated on August 19, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.