Olufeyisayo Jokotola Taiwo, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

036149396 Issued in IL

Practice address

203 Bailey LN
Benton, IL 62812-2270

Phone

(618) 899-4000

NPI assigned

Jun 30, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Obstetrics/Gynecology

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Heartland Women'S Healthcare LTDGroup PAC ID 1759270648, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: olufeyisayo.taiwo.1@21608.direct.athenahealth.com
• Direct secure messaging: otaiwo313630@direct-ehr-ssmhc.com

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.

• Heartland Women'S Healthcare LTD

  • Obstetrics & Gynecology Physician
  • Marion, IL
  • NPI 1851307532
  Medicare reassignment Care Compare group NPD
• Physician Services Corporation of Southern Illinois Inc.

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807

  Obstetrics & Gynecology

  Medicare reassignment NPD
• Heartland Women'S Healthcare LTD

  • Clinical Medical Laboratory
  • Swansea, IL
  • NPI 1043852932
  NPD

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

• Good Samaritan Regional Health Center

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1609897339
  Care Compare affiliation

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1194108712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955860",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631951782",
            "telephone_number": "636-498-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 BAILEY LN",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628122270",
            "telephone_number": "618-899-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 S Fairfield Ave",
            "address_2": "F208",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606081782",
            "country_code": "US",
            "telephone_number": "773-257-2222 x19419",
            "fax_number": "773-522-9831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAIWO",
        "first_name": "OLUFEYISAYO",
        "middle_name": "JOKOTOLA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-30",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "125-067740",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036149396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "otaiwo313630@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "otaiwo313630@direct-ehr-ssmhc.com",
            "address_1": "203 Bailey Ln",
            "city": "Benton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628122270",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "203 Bailey Ln",
            "city": "Benton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628122270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hannah Stock
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• Mariah Stubblefield, MSOTR/L
• David Frank Szoke, M.D.
• Landon Tate
• Teel Chiropractic Clinic, LTD.
• Julie Suzanne Teel, DC
• Tracey Thompson
• Tracy L Thompson, PA-C

• Obstetrics & Gynecology Physician in Benton, IL
• Providers in Benton, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.