Adewumi C Odefadehan, APRN-FPA

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209017467 Issued in IL

Practice address

1005 S Evergreen Ave
Arlington Heights, IL 60005-3144

Phone

(847) 787-3734

Fax

(630) 451-9896

NPI assigned

Apr 30, 2018

Last updated

Apr 7, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Greater Heights P Medical Services

  • Adult Mental Health Clinic/Center
  • Arlington Heights, IL
  • NPI 1568099307
  NPD
• Horizons Behavioral Health LLC

  • Social Worker
  • Crystal Lake, IL
  • NPI 1881692689
  NPD

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

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586217600000",
    "number": "1063900603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 S EVERGREEN AVE",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600053144",
            "telephone_number": "847-787-3734",
            "fax_number": "630-451-9896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 S EVERGREEN AVE",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600053144",
            "telephone_number": "847-787-3734",
            "fax_number": "630-451-9896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODEFADEHAN",
        "first_name": "ADEWUMI",
        "middle_name": "C",
        "credential": "APRN-FPA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-30",
        "last_updated": "2020-04-07",
        "certification_date": "2020-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209017467",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209017467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063900603",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nidal Amin Obeid
• Barbara Ellen Oberg, RN, APN
• Evan S. Oblonsky, M.D.
• Timothy Obmann
• Michael S Obrien, MD
• Mary Odefadehan, FNP-C
• Lara Lynn Odonnell
• Olaide Odutayo
• Odyssey Healthcare Operating a LP (Gentiva I)
• Cynthia Hye-Lin Oh, L.A.

• Psychiatric/Mental Health Nurse Practitioner in Arlington Heights, IL
• Providers in Arlington Heights, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2020; 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.