Individual provider Active NPI

Ibidola Owaduge, M.D.

  • Anesthesiology Physician
  • Detroit, MI
National Provider Identifier
1306106885
Registry record updated Jun 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4301101171 Issued in MI
Practice address
2799 West Grand Boulevard
Henry Ford Hospital
Detroit, MI 48202-2608
Phone
(313) 916-2600
NPI assigned
May 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4301101171 MI Primary

Addresses

Primary practice location

2799 West Grand Boulevard
Henry Ford Hospital
Detroit, MI 48202-2608

Mailing address

2799 West Grand Boulevard
Henry Ford Hospital
Detroit, MI 48202-2608
Phone (313) 916-2600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20160819001632 MI Practitioner - Anesthesiology 9032342282 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Wayne State University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Associates of Ann Arbor PLLCGroup PAC ID 1355317223, 213 clinicians

Practice addresses (Care Compare)

2006 Hogback Rd
Ann Arbor, MI 48105-9750

5301 E Huron River Dr
Ypsilanti, MI 48197-1051
Phone (734) 712-3456

5301 McAuley Dr
Ypsilanti, MI 48197-1051
Phone (734) 712-3456

620 Byron Rd
Howell, MI 48843-1002
Phone (517) 545-6316

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
67.5 of 100Reported as group
Quality
58.12
Improvement activities
40
Cost
68.45

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301101171MIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Michigan III PLLC CurrentSince Mar 1, 2021 Accepting new patients
Anesthesia Associates of Ann Arbor, PLLC Anesthesiology CurrentSince May 25, 2022 Accepting new patients
St Mary Mercy Hospital Crna Anesthesiology CurrentSince Jun 12, 2023 Accepting new patients
Northstar Anesthesia of Michigan PLLC Anesthesiology CurrentSince May 1, 2016 Accepting new patients

Locations

350 E Devon Ave
Itasca, IL 60143

2006 Hogback Rd
Ste 5
Ann Arbor, MI 48105
Phone (313) 712-4331

4201 Saint Antoine St
Detroit, MI 48201
Phone (313) 745-3615

3990 John R St
Detroit, MI 48201
Phone (313) 745-6211

6245 Inkster Rd
Garden City, MI 48135
Phone (734) 421-3300

620 Byron Rd
Howell, MI 48843
Phone (517) 545-5450

36475 5 Mile Rd
Livonia, MI 48154
Phone (734) 464-4800

3601 W 13 Mile Rd
Royal Oak, MI 48073

33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4042

5301 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-7246

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 2

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": "1337299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340668800000",
    "number": "1306106885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2799 WEST GRAND BOULEVARD",
            "address_2": "HENRY FORD HOSPITAL",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 WEST GRAND BOULEVARD",
            "address_2": "HENRY FORD HOSPITAL",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWADUGE",
        "first_name": "IBIDOLA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-18",
        "last_updated": "2012-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301101171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.