NPIMap

Individual provider Active NPI

Agboola Awomolo, M.D.

  • Diagnostic Radiology Physician
  • Chicago, IL
National Provider Identifier
1073877262
Registry record updated Jul 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
3694807 Issued in IL
Practice address
4646 N Marine Dr
Chicago, IL 60640-5759
Phone
(773) 878-8700
NPI assigned
Jul 2, 2012
Last updated
Jul 2, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 3694807 IL Primary

Addresses

Primary practice location

4646 N Marine Dr
Chicago, IL 60640-5759

Mailing address

15537 Ingleside Ave
Dolton, IL 60419-2759
Phone (773) 430-1254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, CA, NV3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20170727002503 AZ Practitioner - Diagnostic Radiology 7416227129 Reassigns benefits to 12 organizations
I20220728002949 CA Practitioner - Diagnostic Radiology 7416227129 Reassigns benefits to 2 organizations
I20250930002002 NV Practitioner - Diagnostic Radiology 7416227129 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Radiology and Interventional Associates IncGroup PAC ID 2163816448, 99 clinicians
Lucidsolutions IncGroup PAC ID 0749603462, 84 clinicians
Valley Radiologists and AssociatesGroup PAC ID 5092798645, 12 clinicians
Radiologica IncGroup PAC ID 8820337769, 46 clinicians

Practice addresses (Care Compare)

1800 N California St
Stockton, CA 95204-6019
Phone (209) 943-2000

1800 W Charleston Blvd
Las Vegas, NV 89102-2329
Phone (702) 383-2000

1890 E Watford CT
Gilbert, AZ 85298-0086
Phone (614) 340-7740

3820 E Piccadilly Rd
Phoenix, AZ 85018-5224
Phone (209) 943-2000

5346 E Royal Palm Rd
Paradise Valley, AZ 85253-2528
Phone (614) 340-7740

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3694807ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cigna Health Care of Arizona Inc. Current Accepting new patients
Kingman Healthcare, Inc CurrentSince May 3, 2023 Accepting new patients
Benson Hospital Corporation CurrentSince Sep 1, 2018 Accepting new patients
Benson Hospital Corporation CurrentSince Sep 1, 2018 Accepting new patients
Southern Inyo Healthcare District CurrentSince Nov 12, 2025 Accepting new patients
University Medical Center of Southern Nevada CurrentSince Sep 1, 2025 Accepting new patients
Cigna Healthcare of Arizona, Inc. CurrentSince Mar 1, 2021 Accepting new patients
University Medical Center of Southern Nevada CurrentSince Sep 1, 2025 Accepting new patients
Radiology Specialists of the Northwest, PC Diagnostic Radiology CurrentSince Oct 1, 2022 Accepting new patients
Lucidsolutions, Inc. Diagnostic Radiology CurrentSince Feb 1, 2024 Accepting new patients
Southern Arizona Rad Associates, LLC Diagnostic Radiology CurrentSince Jul 1, 2018 Accepting new patients
Kingman Healthcare, Inc Current Accepting new patients
Valley Radiologists & Associates Diagnostic Radiology CurrentSince May 17, 2025 Accepting new patients
Cigna Health Care of Arizona Inc. CurrentSince Mar 1, 2021 Accepting new patients
Kingman Healthcare, Inc CurrentSince May 3, 2023 Accepting new patients
Port City Operating Company, LLC Past Accepting new patients
Advanced Medical Imaging Inc Past Accepting new patients
Stewart and Stewart a Medical Corporation Past Accepting new patients

Locations

450 S Ocotillo St
Benson, AZ 85602
Phone (520) 586-2261

5891 W Eugie Ave
Glendale, AZ 85304
Phone (602) 588-6600

3269 N Stockton Hill Rd
Kingman, AZ 86409
Phone (928) 757-0626

6811 E Superstition Springs Blvd
Mesa, AZ 85209
Phone (480) 641-4000

1840 S Stapley Dr
Ste 101
Mesa, AZ 85204
Phone (480) 464-8500

1300 N 12th St
Ste 404
Phoenix, AZ 85006
Phone (602) 839-7000

3003 N 3rd St
Phoenix, AZ 85012
Phone (602) 282-9800

2302 N 75th Ave
Phoenix, AZ 85035
Phone (623) 849-7500

8888 E Raintree Dr
Fl 3
Scottsdale, AZ 85260

155 Calle Portal
Ste 500
Sierra Vista, AZ 85635
Phone (520) 459-5227

13991 W Grand Ave
Ste 105
Surprise, AZ 85374
Phone (623) 455-7800

1920 E Baseline Rd
Tempe, AZ 85283
Phone (480) 345-5000

535 N Wilmot Rd
Ste 101
Tucson, AZ 85711
Phone (520) 694-9988

975 S Fairmont Ave
Lodi, CA 95240
Phone (209) 339-7575

1800 N California St
Stockton, CA 95204
Phone (209) 467-6400

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

5050 NE Hoyt St
Ste 625
Portland, OR 97213
Phone (503) 731-2900

Interoperability endpoints

  • Direct secure messaging: awomolo.agboola@direct.azkrmc.md

Organizations & group practices 24

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.

View all 24

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1341187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341187200000",
    "number": "1073877262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15537 INGLESIDE AVE",
            "city": "DOLTON",
            "state": "IL",
            "postal_code": "604192759",
            "telephone_number": "773-430-1254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 N MARINE DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405759",
            "telephone_number": "773-878-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AWOMOLO",
        "first_name": "AGBOOLA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-02",
        "last_updated": "2012-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "3694807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.