NPIMap

Individual provider Active NPI

Ayodeji B Otegbeye, MD

  • Pediatrics Physician
  • Orlando, FL
National Provider Identifier
1043366131
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME58278 Issued in FL
Practice address
5900 S John Young Pkwy
Orlando, FL 32839-3716
Phone
(407) 398-6470
Fax
(407) 894-6872
NPI assigned
Jan 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X ME0058278 FL
Pediatrics Physician 208000000X ME58278 FL Primary

Addresses

Primary practice location

5900 S John Young Pkwy
Orlando, FL 32839-3716

Mailing address

5900 S John Young Pkwy
Orlando, FL 32839-3716
Phone (407) 398-6470

Other identifiers 1

IdentifierTypeStateIssuer
063905200MedicaidFL

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

State licenses

LicenseStateTypeSpecialty
ME0058278FLMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Night Lite Pediatric Center, LLC Pediatrics Past Accepting new patients
Night Lite Pediatric Center, LLC Pediatrics Past Accepting new patients
Night Lite Pediatric Center, LLC Pediatrics Past Accepting new patients
Night Lite Pediatric Center, LLC Pediatrics Past Accepting new patients
Night Lite Pediatric Center, LLC Pediatrics PastSince Dec 21, 2021 Accepting new patients
Night Lite Pediatric Center, LLC Pediatrics Past Accepting new patients
Night Lite Pediatric Center, LLC Pediatrics Past Accepting new patients
Night Lite Pediatric Center, LLC Pediatrics Past Accepting new patients
Night Lite Pediatric Center, LLC Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: aotegbeye@f0b29e02.micromddirect.com

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1043366131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 S JOHN YOUNG PKWY",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328393716",
            "telephone_number": "407-398-6470",
            "fax_number": "407-894-6872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 S JOHN YOUNG PKWY",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328393716",
            "telephone_number": "407-398-6470",
            "fax_number": "407-894-6872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTEGBEYE",
        "first_name": "AYODEJI",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "FL",
            "license": "ME0058278",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME58278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "063905200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.

Verify at the official NPI Registry.