Individual provider Active NPI

Olayemi O Champion-Odusola, M.D.

  • Family Medicine Physician
  • Munster, IN
National Provider Identifier
1053567040
Registry record updated Apr 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01067004A Issued in IN
Practice address
7905 Calumet Ave
Munster, IN 46321-2549
Phone
(219) 836-5800
Fax
(219) 836-5030
NPI assigned
Aug 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 125051108 IL
Family Medicine Physician 207Q00000X 01067004A IN Primary

Addresses

Primary practice location

7905 Calumet Ave
Munster, IN 46321-2549

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Other identifiers 1

IdentifierTypeStateIssuer
200951320MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ochampionodusola98493@Direct.FranciscanAlliance.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20090910000216 IN Practitioner - Family Practice 3779638036 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

7905 Calumet Ave
Munster, IN 46321-2549
Phone (317) 865-8877

Hospital & facility affiliations

  • Franciscan Home Care Home health agency, Hobart, IN, CCN 157145
  • Franciscan Health Munster Hospital, Munster, IN, CCN 150165
  • Franciscan Health Dyer Hospital, Dyer, IN, CCN 150090
  • St Catherine Hospital Inc Hospital, East Chicago, IN, CCN 150008
  • Community Hospital Hospital, Munster, IN, CCN 150125
  • Franciscan Health Crown Point Hospital, Crown Point, IN, CCN 150126

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125051108ILMDFamily Medicine Physician
01067004AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network Family Medicine CurrentSince Feb 1, 2014 Accepting new patients
Franciscan Physician Network CurrentSince Feb 1, 2014 Accepting new patients

Locations

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

7905 Calumet Ave
Munster, IN 46321
Phone (219) 836-5800

9800 Valparaiso Dr
Munster, IN 46321
Phone (219) 836-5800

11355 W 97th Ln
Saint John, IN 46373
Phone (219) 365-5577

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

Organizations & group practices 2

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": "1218412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681430400000",
    "number": "1053567040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7905 CALUMET AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212549",
            "telephone_number": "219-836-5800",
            "fax_number": "219-836-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPION-ODUSOLA",
        "first_name": "OLAYEMI",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-11",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125051108",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01067004A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200951320",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ochampionodusola98493@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "7905 Calumet Avenue",
            "address_2": "Hammond Clinic LLC",
            "city": "Munster",
            "state": "IN",
            "country_code": "US",
            "postal_code": "606313745",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

Verify at the official NPI Registry.