Oluwamuyiwa Bolonduro, M.D

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

C168133 Issued in CA

Practice address

45104 10TH St W
Lancaster, CA 93534

Phone

(562) 867-7999

NPI assigned

Aug 12, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Muyiwa Bolorunduro Former name

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

Specialty

Obstetrics/Gynecology

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emanate Health Medical Care FoundationGroup PAC ID 9830544980, 85 clinicians

Obhg California PCGroup PAC ID 8729276795, 94 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: oluwanuyiwa.bolundoro.p1@direct.metro.nextgenshare.com
• Direct secure messaging: oluwamuyiwa.bolonduro.p1@direct.northshorehealth.nextgenshare.com
• Direct secure messaging: oluwamuyiwa.bolonduromd.p1@direct.jwch.nextgenshare.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.

• Emanate Health Medical Care Foundation

  • Multi-Specialty Clinic/Center
  • West Covina, CA
  • NPI 1467195073
  Medicare reassignment Care Compare group NPD
• Obhg California, P.C.

  • Obstetrics & Gynecology Physician
  • Greenville, SC
  • NPI 1215258892

  CA

  Medicare reassignment Care Compare group NPD
• JWCH Institute Inc

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1407808058
  Medicare reassignment NPD
• San Marcos Medical Group Inc

  • Obstetrics & Gynecology Physician
  • Fontana, CA
  • NPI 1447446448
  Medicare reassignment NPD
• Dap Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Borrego Springs, CA
  • NPI 1134144165
  NPD
• JWCH Institute Inc

  • Federally Qualified Health Center (FQHC)
  • Lancaster, CA
  • NPI 1073209177
  NPD
• JWCH Institute, Inc.

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1295201044
  NPD
• Northshore Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • East Chicago, IN
  • NPI 1336992999
  NPD
• Northshore Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Merrillville, IN
  • NPI 1477810315

  Obstetrics & Gynecology

  NPD

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

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1215216965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5650 JILLSON ST",
            "city": "COMMERCE",
            "state": "CA",
            "postal_code": "900401482",
            "telephone_number": "323-201-4516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45104 10TH ST W",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "93534",
            "telephone_number": "562-867-7999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 N Rose Ave Ste 280",
            "address_purpose": "LOCATION",
            "city": "Oxnard",
            "state": "CA",
            "postal_code": "930307645",
            "country_code": "US",
            "telephone_number": "805-384-8071",
            "fax_number": "805-278-6477",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 N Rose Ave",
            "address_purpose": "LOCATION",
            "city": "Oxnard",
            "state": "CA",
            "postal_code": "930303722",
            "country_code": "US",
            "telephone_number": "805-988-2500",
            "fax_number": "805-256-7840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2309 Antonio Ave",
            "address_purpose": "LOCATION",
            "city": "Camarillo",
            "state": "CA",
            "postal_code": "930101414",
            "country_code": "US",
            "telephone_number": "805-389-5800",
            "fax_number": "805-256-7840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLONDURO",
        "first_name": "OLUWAMUYIWA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-12",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "01078198A",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "C168133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300002192",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "191360022",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215216965",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CA425840",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MUYIWA",
            "last_name": "BOLORUNDURO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Travis Austin Boisvert
• Edwin Bojorge Calderon, RN
• Brendan John Boland, MD
• Stephanie Dyan Bolanos
• Yvette Bolden
• Juli Marie Bolterman, RRT
• Sacha A Bolton
• Francis Bondzi-Simpson, B. PHARMS (HONS)
• Jessica Lea Bones
• Gina Boni

• Obstetrics & Gynecology Physician in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; 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.