Active NPI
Eromosele Anthony Otoadese, MD
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Waterloo, IA
National Provider Identifier
1013960129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- License
- 28663
- Practice address
- 1753 W Ridgeway Ave Ste 111
Waterloo, IA 50701-4588 - Phone
- (219) 233-6211
- Fax
- (319) 233-2164
- NPI assigned
- May 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 28663 | IA | Primary |
Addresses
Primary practice location
1753 W Ridgeway Ave Ste 111
Waterloo, IA 50701-4588
Mailing address
PO Box 2660
Waterloo, IA 50704-2660
Phone (319) 233-6621
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 46994 | Other | IA | WELLMARK INS PLAN |
| 2091736 | Medicaid | IA | |
| 421417307C4 | Other | IA | JOHN DEERE HEALTH INS PLA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Floyd County Memorial Hospital Commission | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Critical Access Hospital
- Charles City, IA
- NPI 1265402390
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588118400000",
"number": "1013960129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2660",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507042660",
"telephone_number": "319-233-6621",
"fax_number": "319-233-2164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1753 W RIDGEWAY AVE STE 111",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507014588",
"telephone_number": "219-233-6211",
"fax_number": "319-233-2164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTOADESE",
"first_name": "EROMOSELE",
"middle_name": "ANTHONY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2020-04-29",
"certification_date": "2020-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "208G00000X",
"taxonomy_group": "",
"desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
"state": "IA",
"license": "28663",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK INS PLAN",
"identifier": "46994",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2091736",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE HEALTH INS PLA",
"identifier": "421417307C4",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.