Individual provider Active NPI

Oloruntoyin Omoyeni Falola, MD

  • Dermatology Physician
  • San Jose, CA
National Provider Identifier
1205126117
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
S8031 Issued in TX
Practice address
751 S Bascom Ave
San Jose, CA 95128-2604
Phone
(408) 885-5000
NPI assigned
Apr 12, 2011
Last updated
Apr 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X S8031 TX Primary

Addresses

Primary practice location

751 S Bascom Ave
San Jose, CA 95128-2604

Mailing address

13492 Research Blvd Ste 120
Austin, TX 78750-2254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20150707001719 CA Practitioner - Dermatology 4284946195 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Santa ClaraGroup PAC ID 1254244973, 1,000 clinicians

Practice addresses (Care Compare)

751 S Bascom Ave
Santa Clara Vly Med
San Jose, CA 95128-2604
Phone (408) 885-5000

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

State licenses

LicenseStateTypeSpecialty
S8031TXMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara Dermatology Current Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Jan 1, 2016 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Jan 1, 2016 Accepting new patients

Locations

7475 Camino Arroyo
Gilroy, CA 95020
Phone (408) 852-2400

1993 McKee Rd
San Jose, CA 95116
Phone (408) 254-6320

500 Tully Rd
San Jose, CA 95111
Phone (408) 817-1433

750 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-2320

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

660 S Fair Oaks Ave
Sunnyvale, CA 94086
Phone (408) 885-7366

Interoperability endpoints

  • Direct secure messaging: ofalola10565@santaclaravalley.direct-ci.net
  • Direct secure messaging: oloruntoyin.falola.1@8363.direct.athenahealth.com

Organizations & group practices 5

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 1

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": "1302566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1205126117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13492 RESEARCH BLVD STE 120",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787502254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 S BASCOM AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282604",
            "telephone_number": "408-885-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALOLA",
        "first_name": "OLORUNTOYIN",
        "middle_name": "OMOYENI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-12",
        "last_updated": "2024-04-30",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "S8031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.