Olugbenga Alaba Adebanjo, M.D
Individual provider Active NPI Internal Medicine Physician · Memphis, TN
NPI 1144274200 · NPPES record last updated May 30, 2021
Key facts
- NPI
- 1144274200
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 37598 (TN)
- Practice address
- 1719 Kirby Pkwy
Memphis, TN 38120-4367 - Phone
- (901) 685-1994
- Fax
- (901) 685-1997
- NPI assigned
- May 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Goodlife Medical Center, PLLC
Physiotherapy Associates Inc
Practice addresses (Care Compare)
1719 Kirby Pkwy
Memphis, TN 38120-4367
Phone (901) 685-1994
1785 Nonconnah Blvd
Memphis, TN 38132-2139
Phone (901) 344-0101
Hospital & facility affiliations
- Methodist Hospitals of Memphis
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in TN, AR, MS, MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040219000753 | TN | Practitioner - Internal Medicine |
3779478557 | Reassigns benefits to 1 organization |
| I20191028000909 | AR | Practitioner - Internal Medicine | 3779478557 | Reassigns benefits to 2 organizations |
| I20200313001558 | MS | Practitioner - Internal Medicine |
3779478557 | Reassigns benefits to 1 organization |
| I20220525000935 | MO | Practitioner - Internal Medicine | 3779478557 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37598 | TN | MD | Pharmacist |
| E-12557 | AR | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pemiscot County Memorial Hospital | Current |
Accepting new patients | |
| East Arkansas Emergency Physicians, PLLC | Emergency Medicine | Current | Accepting new patients |
| Southeastern Emergency Physicians LLC | Emergency Medicine | Current |
Accepting new patients |
| Pemiscot County Memorial Hospital | Current |
Accepting new patients | |
| Correct Care, Inc. | Emergency Medicine | Current |
Accepting new patients |
| East Arkansas Emergency Physicians, PLLC | Emergency Medicine | Current |
Accepting new patients |
| East Arkansas Emergency Physicians, PLLC | Emergency Medicine | Current |
Accepting new patients |
| Goodlife Medical Center, PLLC | Internal Medicine | Current |
Accepting new patients |
| Bolivar General Hospital, Inc. | Past | Accepting new patients | |
| Bolivar General Hospital, Inc. | Past | Accepting new patients |
Locations
1520 N Division St
Blytheville, AR 72315
Phone (870) 838-7300
4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100
611 W Lee Ave
Osceola, AR 72370
Phone (870) 563-7000
2100 N 7th St
West Memphis, AR 72301
Phone (870) 394-7800
229 Saint John Ln
Covington, LA 70433
Phone (866) 875-9225
946 E Reed St
Hayti, MO 63851
Phone (573) 359-3408
409 Tyler Holmes Dr
Winona, MS 38967
Phone (662) 283-3060
1719 Kirby Pkwy
Memphis, TN 38120
Phone (901) 685-1994
756 Ridge Lake Blvd
Ste 228
Memphis, TN 38120
Phone (901) 522-6910
Interoperability endpoints
- oadebanjo31539@mlh.direct-ci.com
- https://fhir4.healow.com/fhir/r4/EHFEDD/Endpoint/EHFEDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | E-12557 | AR | |
| Internal Medicine Physician | 207R00000X | E-12557 | AR | |
| Internal Medicine Physician | 207R00000X | 37598 | TN | Yes |
Addresses
Primary practice location
1719 Kirby Pkwy
Memphis, TN 38120-4367
Mailing address
PO Box 172126
Memphis, TN 38187-2126
Phone (901) 685-1994
Other providers in Memphis, TN
- Elisabeth E Adderson
- Jeffrey Addess
- Addiction & Mental Health Services, LLC
- Amanda Addington
- Milton Alexander Addington
- Titilola Tolulope Adebanjo
- Omoniyi Yakubu Adebisi
- Adedayo Ademola Adeboye
- Oluwatobi Adedayo Adedokun
- Stephen Deji Adedokun
All providers in Memphis, TN · Internal Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.