Kolawole Ademuyiwa Odulaja, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

N2694 Issued in TX

Practice address

510 Med CT
Suite 107
San Antonio, TX 78258-3482

Phone

(210) 455-0074

Fax

(210) 455-0124

NPI assigned

Nov 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY, TX2 enrollments

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 2

Specialty

Internal Medicine

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Multiviz Medical Services PCGroup PAC ID 1557274735, 26 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Girling Health Care of New York Home health agency, Brooklyn, NY, CCN 337243
• Vnsny Hospice and Palliative Care Hospice, New York, NY, CCN 331519
• St John'S Episcopal Hospital at South Shore Hospital, Far Rockaway, NY, CCN 330395
• Brookhaven Rehab & Health Care Center L L C Nursing home, Far Rockaway, NY, CCN 335582
• Eastchester Rehabilitation and Health Care Center Nursing home, Bronx, NY, CCN 335214
• The Paramount At Somers Rehab And Nursing Center Nursing home, Somers, NY, CCN 335261
• The Phoenix Rehabilitation and Nursing Center Nursing home, Brooklyn, NY, CCN 335516

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Multiviz Medical Services PC

  • Internal Medicine Physician
  • Far Rockaway, NY
  • NPI 1720373293
  Medicare reassignment Care Compare group NPD
• Longhorn Emergency Medical Associates PA

  • Emergency Medicine Physician
  • Austin, TX
  • NPI 1649669672
  Medicare reassignment NPD
• Maverick Emergency Medicine Associates PA

  • Emergency Medicine Physician
  • Eagle Pass, TX
  • NPI 1306806781
  Medicare reassignment NPD
• Cane Grass Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Carrizo Springs, TX
  • NPI 1316283476
  NPD (past)
• Port Arthur Emergency Physicians

  • Emergency Medicine Physician
  • Port Arthur, TX
  • NPI 1255491627
  NPD (past)
• Royal Suntomed Medical Group

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1922272574
  NPD (past)
• Texas Em-1 Medical Services, PA

  • Physician Assistant
  • Texarkana, TX
  • NPI 1558314062
  NPD (past)
• Texas Emergency Room Services, PA

  • Emergency Medicine Physician
  • Hondo, TX
  • NPI 1275584781
  NPD (past)
• Wellmed Medical Group, PA

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1437156486
  NPD (past)
• Brookhaven Rehabilitation and Health Care Center LLC

  • Skilled Nursing Facility
  • Far Rockaway, NY
  • NPI 1477609188
  NPD (past)
• Downtown Bronx Medical Associates PC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Bronx, NY
  • NPI 1689618407
  NPD (past)
• Eastchester Rehabilitation and Health Care Center LLC

  • Skilled Nursing Facility
  • Bronx, NY
  • NPI 1902974058
  NPD (past)

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

• Atlantis Operating LLC

  • Skilled Nursing Facility
  • Brooklyn, NY
  • NPI 1366847451

  Nursing home

  Care Compare affiliation
• Eastchester Rehabilitation and Health Care Center LLC

  • Skilled Nursing Facility
  • Bronx, NY
  • NPI 1902974058

  Nursing home

  Care Compare affiliation
• HCS Certified Home Care Ny Inc

  • Home Health Agency
  • Brooklyn, NY
  • NPI 1568886653
  Care Compare affiliation
• Somers Operating LLC

  • Skilled Nursing Facility
  • Somers, NY
  • NPI 1295253284

  Nursing home

  Care Compare affiliation
• Visiting Nurse Service of New York Hospice Care

  • Community Based Hospice Care Agency
  • New York, NY
  • NPI 1215928510
  Care Compare affiliation

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468972800000",
    "number": "1043384654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 MED CT",
            "address_2": "SUITE 107",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583482",
            "telephone_number": "210-455-0074",
            "fax_number": "210-455-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 MED CT",
            "address_2": "SUITE 107",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583482",
            "telephone_number": "210-455-0074",
            "fax_number": "210-455-0124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODULAJA",
        "first_name": "KOLAWOLE",
        "middle_name": "ADEMUYIWA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2016-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N2694",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "N2694",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201404510",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TEXAS",
            "identifier": "8CJ963",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McKenna Boyd Odom, MD
• Michael Odom, M.D.
• Susan Dean Odom, PH.D.
• Madison Odonnell
• Michael Odonnell, RPH.
• Cynthia Denise Odum
• Aimalohi Omiororo Odumosu, RPH
• Stephen Folorunso Odumosu, RPH
• Tosin Oduwusi
• Odyssey Healthcare Operating a LP

• Internal Medicine Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.