NPIMap

Individual provider Active NPI

Oluwagbenga Serrano, MD

  • Gastroenterology Physician
  • Vincennes, IN
National Provider Identifier
1235131806
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
01049379A Issued in IN
Practice address
1813 Willow St Ste 5B
Vincennes, IN 47591-4279
Phone
(812) 882-2703
Fax
(812) 882-2760
NPI assigned
Aug 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 2160261 NY
Gastroenterology Physician 207RG0100X 8773 SD
Gastroenterology Physician 207RG0100X 01049379A IN Primary

Addresses

Primary practice location

1813 Willow St Ste 5B
Vincennes, IN 47591-4279

Mailing address

1813 Willow St Ste 5B
Vincennes, IN 47591-4279
Phone (812) 882-2703

Other identifiers 4

IdentifierTypeStateIssuer
201207410MedicaidIN
000001180285OtherINANTHEM
258190110OtherINMEDICARE
639396MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20140213001611 IN Practitioner - GastroenterologyPractitioner - Internal Medicine 3678485877 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

328 N 2ND St
Vincennes, IN 47591-1351
Phone (812) 882-3312

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy190
Upper gastrointestinal (GI) endoscopy for acid reflux369

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2160261NYMDGastroenterology Physician
8773SDMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Physician Services, Inc Gastroenterology CurrentSince Jun 11, 2018 Accepting new patients
O.Serrano, M.D. PLLC Gastroenterology Current Accepting new patients
Good Samaritan Hospital CurrentSince Jun 11, 2018 Accepting new patients
Good Samaritan Hospital Physician Services Inc. Past Accepting new patients

Locations

520 S 7th St
Vincennes, IN 47591
Phone (812) 885-3280

328 N 2nd St
Vincennes, IN 47591
Phone (812) 882-3312

1813 Willow St
Ste 5B
Vincennes, IN 47591
Phone (812) 882-2703

328 N 2nd St
Ste 307
Vincennes, IN 47591
Phone (812) 882-1000

1160 E Saint Clair St
Vincennes, IN 47591
Phone (812) 882-1064

328 N 2nd St
Ste 202
Vincennes, IN 47591

Interoperability endpoints

  • Direct secure messaging: oserrano200330@direct.deaconess.com

Organizations & group practices 4

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.

Hospital & facility affiliations 10

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": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1235131806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1813 WILLOW ST STE 5B",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475914279",
            "telephone_number": "812-882-2703",
            "fax_number": "812-882-2760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 WILLOW ST STE 5B",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475914279",
            "telephone_number": "812-882-2703",
            "fax_number": "812-882-2760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERRANO",
        "first_name": "OLUWAGBENGA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "2160261",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "SD",
            "license": "8773",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "01049379A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201207410",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000001180285",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "258190110",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "639396",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vincennes, IN

Sources for this page

Verify at the official NPI Registry.