Mojolaoluwa Mabayoje

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

90200000X Issued in NU

Practice address

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Phone

(347) 841-4303

NPI assigned

Apr 22, 2019

Last updated

Apr 22, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: mmabayoje326655@direct.phhs.org

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

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555891200000",
    "number": "1225691561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 S CLAREMONT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "347-841-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MABAYOJE",
        "first_name": "MOJOLAOLUWA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-22",
        "last_updated": "2019-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": "90200000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Lynch, M.D.
• Lynne M Jalovec, MD, SC
• Cheryl Renee Lyons, RN BSN
• M. Craig Counseling Services, LLC
• Lindsey A Ma, M.D.
• Ashley Mabry
• Macarius, Max & Daniel, LLC (Stanton Optical)
• Jaclyn Macdonald, DMD
• Melissa Dawn Macdonald, APRN, CNP
• Carly Michelle Machacek, DPT

• Student in an Organized Health Care Education/Training Program in Peoria, IL
• Providers in Peoria, IL by specialty
• Student in an Organized Health Care Education/Training Program in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.