Individual provider Active NPI

Olaitan Atinuke Ijitimehin, MD

  • Internal Medicine Physician
  • Davenport, IA
National Provider Identifier
1275067696
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD-47083 Issued in IA
Practice address
500 W River Dr
Davenport, IA 52801-1014
Phone
(563) 327-2035
NPI assigned
Apr 12, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X MD-47083 IA Primary

Addresses

Primary practice location

500 W River Dr
Davenport, IA 52801-1014

Mailing address

500 W River Dr
Davenport, IA 52801-1014
Phone (563) 327-2035

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20200728003098 IA Practitioner - Internal Medicine 1254756943 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Health Care IncGroup PAC ID 9830008895, 56 clinicians

Practice addresses (Care Compare)

500 W River Dr
Davenport, IA 52801-1014
Phone (563) 336-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-47083IAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Care, Inc. Current Accepting new patients
Community Health Care Inc CurrentSince Jul 20, 2020 Accepting new patients
Community Health Care, Inc. CurrentSince Jul 20, 2020 Accepting new patients

Locations

925 S 4th St
Clinton, IA 52732
Phone (563) 205-3578

500 W River Dr
Davenport, IA 52801
Phone (563) 327-2035

1510 E Rusholme St
Davenport, IA 52803
Phone (563) 359-6633

1221 Park Ave
Muscatine, IA 52761

312 Iowa Ave
Muscatine, IA 52761
Phone (563) 264-8506

2925 Cedar St
Ste 2
Muscatine, IA 52761
Phone (563) 263-7410

Interoperability endpoints

  • Direct secure messaging: oijitimehin635486@direct.ochin.org

Organizations & group practices 3

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 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": "1491955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1275067696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-327-2035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-327-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IJITIMEHIN",
        "first_name": "OLAITAN",
        "middle_name": "ATINUKE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-12",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "MD-47083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.