NPIMap

Individual provider Active NPI

Olufunke O Ajayi, MBBS

  • Family Medicine Physician
  • Saint Cloud, MN
National Provider Identifier
1093195489
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
63031 Issued in MN
Practice address
Centracare Clinic St Cloud Medical Group South
1301 33Rd St S
Saint Cloud, MN 56301-9668
Phone
(320) 251-8181
Fax
(320) 257-1733
NPI assigned
Jun 1, 2015
Last updated
Aug 7, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 63031 MN Primary

Addresses

Primary practice location

Centracare Clinic St Cloud Medical Group South
1301 33Rd St S
Saint Cloud, MN 56301-9668

Mailing address

Centracare Clinic St Cloud Medical Group South
1301 33Rd St S
Saint Cloud, MN 56301-9668
Phone (320) 251-8181

Other names 1

  • Dr. Olufunke Ikuopenikan Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180910001993 MN Practitioner - Family Practice 4587962485 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), 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1301 33Rd St S
St Cloud, MN 56301-9668
Phone (320) 251-8181

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
Centracare Clinic CurrentSince Jan 8, 2020 Accepting new patients

Locations

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1301 33rd St S
Saint Cloud, MN 56301
Phone (320) 240-6955

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: oajayi417468@direct.centracare.com

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

Hospital & facility affiliations 7

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": "1433116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533600000000",
    "number": "1093195489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CENTRACARE CLINIC ST CLOUD MEDICAL GROUP SOUTH",
            "address_2": "1301 33RD ST S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563019668",
            "telephone_number": "320-251-8181",
            "fax_number": "320-257-1733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CENTRACARE CLINIC ST CLOUD MEDICAL GROUP SOUTH",
            "address_2": "1301 33RD ST S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563019668",
            "telephone_number": "320-251-8181",
            "fax_number": "320-257-1733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJAYI",
        "first_name": "OLUFUNKE",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "MBBS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-01",
        "last_updated": "2018-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "63031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OLUFUNKE",
            "last_name": "IKUOPENIKAN",
            "prefix": "DR.",
            "credential": "MBBS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.