Bolanle O. Gbadebo, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

46201 Issued in WI

Practice address

9939 State Highway 151
San Antonio, TX 78251-1900

Phone

(210) 949-9702

Fax

(210) 443-0333

NPI assigned

Oct 16, 2006

Last updated

Mar 5, 2025By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Enrolled in WI

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

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Aspirus Stevens Point Hospital & Clinics, Inc.

  • General Acute Care Hospital
  • Stevens Point, WI
  • NPI 1538112230
  Medicare reassignment NPD
• Jasper Doctors Clinic and Urgent Care Inc.

  • Family Medicine Physician
  • Jasper, AL
  • NPI 1831353846
  NPD (past) Authorized official
• Jasper Urgent Care

  • Family Medicine Physician
  • Jasper, AL
  • NPI 1588686505
  NPD (past) Authorized official
• Aspirus Stevens Point Hospital & Clinics, Inc.

  dba Aspirus Behavioral Health Clinic - Stevens Point - Prentice St

  • Clinic/Center
  • Stevens Point, WI
  • NPI 1679706022
  NPD

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1245320480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 MERTON MINTER ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294404",
            "telephone_number": "920-217-0539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9939 STATE HIGHWAY 151",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782511900",
            "telephone_number": "210-949-9702",
            "fax_number": "210-443-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GBADEBO",
        "first_name": "BOLANLE",
        "middle_name": "O.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "46201",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "28814",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34586000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caroline Diane Gaynor, DPM
• Devin Donn Marte Gayoles
• Ana E Gaytan
• Gerarado Gaytan
• Leslie Gaytan
• June Marie Gbapaywea, RN
• Gcsa Ambulatory Surgery Center, LLC (Gastroenterology Consultants of San Antonio - Stone Oak)
• Gcsa Ambulatory Surgery Center, LLC
• Gcsa Anesthesia PLLC (Alamo City Endoscopy Anesthesia)
• Lu Ge, PHARM.D.

• Family Medicine Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.