Oladiji Gbolahan Vaughan, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

40162 Issued in AZ

Practice address

36351 N Gantzel Rd Ste 127
San Tan Valley, AZ 85140-7033

Phone

(480) 336-2815

Fax

(877) 281-3385

NPI assigned

Feb 6, 2008

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 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: oladiji.vaughan.1@21546.direct.athenahealth.com

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.

• Springfield Medical LLC

  • Pediatrics Physician
  • San Tan Valley, AZ
  • NPI 1093019150
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1043498520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36351 N GANTZEL RD STE 127",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851407033",
            "telephone_number": "480-336-2815",
            "fax_number": "877-281-3385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36351 N GANTZEL RD STE 127",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851407033",
            "telephone_number": "480-336-2815",
            "fax_number": "877-281-3385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2400 S Avenue A",
            "address_purpose": "LOCATION",
            "city": "Yuma",
            "state": "AZ",
            "postal_code": "853647127",
            "country_code": "US",
            "telephone_number": "928-344-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "OLADIJI",
        "middle_name": "GBOLAHAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-06",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AZ",
            "license": "40162",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "40162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "358032-01",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Untamed Rose Therapy LLC
• Daisy Valencia Vivar, SLPA
• Erica Renae Van Beuge, PA-C
• Ryan Vance, PT
• Dalene Vasconcelles, LPN
• James Verdieu
• Victory Health Home PLLC
• Victory Residential Corporation
• Hunter Vincent, PT
• Katelyn Anne Virnelson, PA-C

• Pediatrics Physician in San Tan Valley, AZ
• Providers in San Tan Valley, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.