Individual provider Active NPI

Oluwadamilola Daniel Odutola, MD

  • Internal Medicine Physician
  • Kingwood, TX
National Provider Identifier
1255994620
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
V9080 Issued in TX
Practice address
22751 Professional Dr Ste 120
Kingwood, TX 77339-6022
Phone
(346) 842-6619
NPI assigned
Apr 20, 2019
Last updated
Jul 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 87643 SC
Student in an Organized Health Care Education/Training Program 390200000X NY
Internal Medicine Physician 207R00000X V9080 TX Primary

Addresses

Primary practice location

22751 Professional Dr Ste 120
Kingwood, TX 77339-6022

Mailing address

PO Box 23321
New York, NY 10087-3321
Phone (843) 792-6200

Other practice location 1

4422 3rd Ave
Bronx, NY 10457-2545
Phone (718) 960-6202

Other practice location 2

805 Pamplico Hwy
Florence, SC 29505-6047
Phone (843) 792-1414

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220730000079 SC Practitioner - Internal Medicine 0749662229 Reassigns benefits to 1 organization
I20250818004490 TX Practitioner - Internal Medicine 0749662229 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Specialty Associates of West Houston PLLCGroup PAC ID 6800056177, 125 clinicians
Trumen Physician and Associates Post Acute PLLCGroup PAC ID 5496236788, 127 clinicians
Trumen Physicians and Associates PLLCGroup PAC ID 7618006883, 133 clinicians

Practice addresses (Care Compare)

22751 Professional Dr
Suite 120
Kingwood, TX 77339-6024
Phone (281) 312-4838

2626 S Loop W
Suite 265
Houston, TX 77054-5636
Phone (713) 796-9955

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
V9080TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Neurosurgery of Kingwood, PLLC CurrentSince Jul 1, 2025 Accepting new patients
Musc Community Physicians CurrentSince May 11, 2022 Accepting new patients
Specialty Associates of West Houston PLLC Internal Medicine CurrentSince Jul 1, 2025 Accepting new patients
Musc Community Physicians Internal Medicine CurrentSince May 11, 2022 Accepting new patients
Medical University Hospital Authority Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

805 Pamplico Hwy
Florence, SC 29505
Phone (843) 674-2500

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

1140 Business Center Dr
Ste 490
Houston, TX 77043
Phone (713) 932-1247

22751 Professional Dr
Ste 120
Kingwood, TX 77339
Phone (281) 312-4838

15200 Southwest Fwy
Ste 290
Sugar Land, TX 77478
Phone (281) 980-2010

Interoperability endpoints

  • Direct secure messaging: oluwadamilola.odutola.1@18107.direct.athenahealth.com
  • Direct secure messaging: oluwadamilola.odutola@hca9.eclinicaldirectplus.com

Organizations & group practices 7

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": "1555718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752019200000",
    "number": "1255994620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23321",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873321",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22751 PROFESSIONAL DR STE 120",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773396022",
            "telephone_number": "346-842-6619"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4422 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104572545",
            "country_code": "US",
            "telephone_number": "718-960-6202",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "805 Pamplico Hwy",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "SC",
            "postal_code": "295056047",
            "country_code": "US",
            "telephone_number": "843-792-1414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODUTOLA",
        "first_name": "OLUWADAMILOLA",
        "middle_name": "DANIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-20",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "SC",
            "license": "87643",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "V9080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingwood, TX

Sources for this page

Verify at the official NPI Registry.