Individual provider Active NPI

Olugbenga Ayooluwa Salako, MBCHB

  • Internal Medicine Physician
  • Worcester, MA
National Provider Identifier
1306428172
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
1019115 Issued in MA
Practice address
291 Lincoln St
Worcester, MA 01605-3643
Phone
(508) 334-8409
Fax
(508) 334-8408
NPI assigned
Apr 22, 2021
Reactivated
Mar 14, 2022
Last updated
Aug 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 1019115 MA Primary

Addresses

Primary practice location

291 Lincoln St
Worcester, MA 01605-3643

Mailing address

PO Box 415348 MLK 13-106
Boston, MA 02241-5348
Phone (800) 225-8885

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20240826002113 MA Practitioner - Internal Medicine 3577002237 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

291 Lincoln St
Suite 101
Worcester, MA 01605-3643
Phone (508) 752-7888

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1019115MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Group Inc Internal Medicine CurrentSince Aug 16, 2024 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Aug 16, 2024 Accepting new patients

Locations

291 Lincoln St
Worcester, MA 01605
Phone (508) 334-6251

291 Lincoln St
Ste 101
Worcester, MA 01605
Phone (508) 752-7888

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Organizations & group practices 2

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 6

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": "1619049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1306428172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348 MLK 13-106",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348",
            "telephone_number": "800-225-8885",
            "fax_number": "508-334-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016053643",
            "telephone_number": "508-334-8409",
            "fax_number": "508-334-8408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALAKO",
        "first_name": "OLUGBENGA",
        "middle_name": "AYOOLUWA",
        "name_prefix": "Dr.",
        "credential": "MBCHB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-22",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "deactivation_date": "2022-02-24",
        "reactivation_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "1019115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.