NPIMap

Individual provider Active NPI

Mary Oduyela

  • Hospitalist Physician
  • Brooklyn, NY
National Provider Identifier
1144602996
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
295434 Issued in NY
Practice address
121 Dekalb Ave
Brooklyn, NY 11201-5425
Phone
(718) 250-6946
NPI assigned
Jun 28, 2015
Last updated
Oct 24, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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 NY
Hospitalist Physician 208M00000X 295434 NY Primary

Addresses

Primary practice location

121 Dekalb Ave
Brooklyn, NY 11201-5425

Mailing address

301 E Main St
Bay Shore, NY 11706-8408

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20180911000564 NY Practitioner - HospitalistPractitioner - Internal Medicine 2163772294 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians
Southwest Suffolk Medical PCGroup PAC ID 0244396349, 204 clinicians

Practice addresses (Care Compare)

301 E Main St
Bay Shore, NY 11706-8408
Phone (631) 986-3308

50 Route 25a
Smithtown, NY 11787-1348
Phone (631) 862-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
295434NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC Hospitalist CurrentSince Aug 27, 2018 Accepting new patients
Southwest Suffolk Medical, P.C. Current Accepting new patients
Hospitalist Medicine Physicians of New York, PLLC CurrentSince Jan 1, 2022 Accepting new patients
C Doc Medical Group PLLC CurrentSince Mar 8, 2022 Accepting new patients
Southwest Suffolk Medical PC CurrentSince Jun 26, 2023 Accepting new patients
Cogent Medical Care PC Hospitalist CurrentSince Jan 1, 2022 Accepting new patients

Locations

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

4295 Hempstead Tpke
Bethpage, NY 11714
Phone (516) 520-2250

55 Greene Ave
Ste 2B
Brooklyn, NY 11238
Phone (718) 517-2900

565 Abbott Rd
Rm 8632
Buffalo, NY 14220
Phone (607) 798-5671

300 Community Dr
Manhasset, NY 11030

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

50 Route 25A
Smithtown, NY 11787
Phone (631) 465-6225

972 Brush Hollow Rd
Westbury, NY 11590

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 6

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 8

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": "1435449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1144602996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 E MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 DEKALB AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015425",
            "telephone_number": "718-250-6946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODUYELA",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-28",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "295434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.