Individual provider Active NPI

Ayomide Odeneye, MD

  • Psychiatry Physician
  • Tucson, AZ
National Provider Identifier
1306634910
Registry record updated Apr 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
R81637 Issued in AZ
Practice address
2800 E Ajo Way
Tucson, AZ 85713-6204
Phone
(520) 874-4501
Fax
(520) 874-7539
NPI assigned
Apr 25, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X R81637 AZ Primary

Addresses

Primary practice location

2800 E Ajo Way
Tucson, AZ 85713-6204

Mailing address

2800 E Ajo Way
Tucson, AZ 85713-6204

Other identifiers 1

IdentifierTypeStateIssuer
R81637OtherAZARIZONA MEDICAL BOARD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20250709003456 AZ Order and Referring Only - PsychiatryPractitioner - Psychiatry 0749794873

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1745539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745539200000",
    "number": "1306634910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 E AJO WAY",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857136204",
            "fax_number": "520-874-7539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 E AJO WAY",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857136204",
            "telephone_number": "520-874-4501",
            "fax_number": "520-874-7539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODENEYE",
        "first_name": "AYOMIDE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-04-25",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AZ",
            "license": "R81637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA MEDICAL BOARD",
            "identifier": "R81637",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.