Individual provider Active NPI

Adebisi I Obafemi, MD

  • Internal Medicine Physician
  • Dallas, TX
National Provider Identifier
1336310333
Registry record updated Jun 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
N5292 Issued in TX
Practice address
5323 Harry Hines Blvd.
Dallas, TX 75390-7201
Phone
(214) 645-8600
Fax
(214) 645-8601
NPI assigned
Mar 18, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 38034 AZ
Internal Medicine Physician 207R00000X N5292 TX Primary

Addresses

Primary practice location

5323 Harry Hines Blvd.
Dallas, TX 75390-7201

Mailing address

P.O. Box 845347
Dallas, TX 75284-5347
Phone (214) 645-8600

Other identifiers 2

IdentifierTypeStateIssuer
337355MedicaidAZ
P00646320OtherAZRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20120621000394 TX Practitioner - Internal MedicinePractitioner - Family PracticePractitioner - Preventive Medicine 8224109004 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
N5292TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 1, 2012 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 1, 2012 Accepting new patients

Locations

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

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.

NPI Registry JSON

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

{
    "created_epoch": "1205798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339113600000",
    "number": "1336310333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 845347",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752845347",
            "telephone_number": "214-645-8600",
            "fax_number": "214-645-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5323 HARRY HINES BLVD.",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753907201",
            "telephone_number": "214-645-8600",
            "fax_number": "214-645-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBAFEMI",
        "first_name": "ADEBISI",
        "middle_name": "I",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-18",
        "last_updated": "2012-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "38034",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N5292",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "337355",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00646320",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.