Individual provider Active NPI

Olumuyiwa Adedotun Ibikunle, M.D

  • Internal Medicine Physician
  • Summit, NJ
National Provider Identifier
1013112069
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA08476800 Issued in NJ
Practice address
99 Beauvoir Ave
Summit, NJ 07901-3533
Phone
(908) 522-2000
NPI assigned
Jun 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 25MA08476800 NJ
Internal Medicine Physician 207R00000X 25MA08476800 NJ Primary

Addresses

Primary practice location

99 Beauvoir Ave
Summit, NJ 07901-3533

Mailing address

PO Box 416457
Boston, MA 02241-6457
Phone (844) 362-1735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090702000124 NJ Practitioner - Internal Medicine 8224189261 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Practice Associates Medical GroupGroup PAC ID 5890703177, 1,412 clinicians

Practice addresses (Care Compare)

99 Beauvoir Ave
Summit, NJ 07902-3533
Phone (908) 522-2000

Hospital & facility affiliations

  • Overlook Medical Center Hospital, Summit, NJ, CCN 310051
  • Memorial Hospital for Cancer and Allied Diseases Hospital, New York, NY, CCN 330154

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Practice Associates Medical Group Internal Medicine CurrentSince Aug 23, 2017 Accepting new patients
Ahs Hospital Corp. Past Accepting new patients

Locations

100 Madison Ave
Morristown, NJ 07960
Phone (973) 538-5210

465 South St
Ste 200
Morristown, NJ 07960
Phone (973) 971-7130

99 Beauvoir Ave
Summit, NJ 07901
Phone (908) 522-2232

266 King George Rd
Ste D
Warren, NJ 07059
Phone (732) 662-3050

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1013112069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416457",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416457",
            "telephone_number": "844-362-1735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 BEAUVOIR AVE",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079013533",
            "telephone_number": "908-522-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBIKUNLE",
        "first_name": "OLUMUYIWA",
        "middle_name": "ADEDOTUN",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "25MA08476800",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08476800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summit, NJ

Sources for this page

Verify at the official NPI Registry.