Individual provider Active NPI

Olusegun O. Osinbowale, M.D.

  • Internal Medicine Physician
  • Detroit, MI
National Provider Identifier
1114065547
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301119316 Issued in MI
Practice address
2799 W Grand Blvd
Detroit, MI 48202-2608
Phone
(919) 397-9772
NPI assigned
Feb 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35-0836040 OH
Cardiovascular Disease Physician 207RC0000X MD.202262 LA
Cardiovascular Disease Physician 207RC0000X 2016-01051 NC
Cardiovascular Disease Physician 207RC0000X 4301119316 MI
Internal Medicine Physician 207R00000X 4301119316 MI Primary

Addresses

Primary practice location

2799 W Grand Blvd
Detroit, MI 48202-2608

Mailing address

Henry Ford Health System
2799 W. Grand Blvd.
Detroit, MI 48202
Phone (919) 397-9772

Other identifiers 3

IdentifierTypeStateIssuer
1313815MedicaidLA
05559318MedicaidMS
1114065547MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20190701000181 MI Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal MedicinePractitioner - Family Practice 9931202207 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Cincinnati College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Semi Medical GroupGroup PAC ID 0648180406, shared by 4 NPIs, 246 clinicians
Henry Ford Wyandotte HospitalGroup PAC ID 2264334499, 194 clinicians
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

17900 23 Mile Rd
Macomb, MI 48044-1161
Phone (313) 647-3900

2333 Biddle Ave
Wyandotte, MI 48192-4668
Phone (734) 246-6000

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-0836040OHMDInternal Medicine Physician
2016-01051NCMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Wyandotte Hospital Cardiovascular Disease CurrentSince Dec 1, 2022 Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince Dec 1, 2022 Accepting new patients
Henry Ford Health System Cardiovascular Disease CurrentSince Jun 12, 2019 Accepting new patients
Henry Ford Health System Current Accepting new patients
Henry Ford Health System CurrentSince Jun 12, 2019 Accepting new patients
Rex Hospital Inc Cardiovascular Disease Past Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients

Locations

1961 S Telegraph Rd
Bloomfield Township, MI 48302
Phone (248) 319-6190

23050 West Rd
Ste 120
Brownstown Twp, MI 48183
Phone (734) 671-1510

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

2799 W Grand Blvd
#5
Detroit, MI 48202
Phone (313) 916-2710

6777 W Maple Rd
West Bloomfield, MI 48322
Phone (248) 325-1000

2333 Biddle Ave
Wyandotte, MI 48192
Phone (734) 246-6000

2070 Biddle Ave
Ste 2
Wyandotte, MI 48192
Phone (734) 284-7482

Interoperability endpoints

  • Direct secure messaging: oosinbowale573465@direct.hfhs.org

Organizations & group practices 7

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 5

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": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1114065547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HENRY FORD HEALTH SYSTEM",
            "address_2": "2799 W. GRAND BLVD.",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48202",
            "telephone_number": "919-397-9772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "919-397-9772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSINBOWALE",
        "first_name": "OLUSEGUN",
        "middle_name": "O.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-0836040",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "LA",
            "license": "MD.202262",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NC",
            "license": "2016-01051",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301119316",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301119316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1313815",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05559318",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114065547",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.