NPIMap

Individual provider Active NPI

Adebola Sulaiman Olatunji, M.D.

  • Internal Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1356308381
Registry record updated Jan 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
L9833 Issued in TX
Practice address
654 Saint Louis Ave
Fort Worth, TX 76104-3358
Phone
(817) 386-9818
Fax
(817) 386-9821
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2022

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 L9833 TX Primary

Addresses

Primary practice location

654 Saint Louis Ave
Fort Worth, TX 76104-3358

Mailing address

650 Saint Louis Ave
Fort Worth, TX 76104-3346
Phone (817) 386-9818

Other identifiers 1

IdentifierTypeStateIssuer
167928402MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040928000680 TX Practitioner - Internal Medicine 8426027335 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sciometrix IncGroup PAC ID 9335511443, 46 clinicians
Fort Worth Internal Medicine PAGroup PAC ID 0749381572, 2 clinicians

Practice addresses (Care Compare)

1485 FM 1960 Bypass Rd E
Suite 100
Humble, TX 77338-3965
Phone (810) 270-8055

654 Saint Louis Ave
Fort Worth, TX 76104-3358
Phone (817) 386-9818

Hospital & facility affiliations

  • Prim Palliative & Hospice Care Inc Hospice, Plano, TX, CCN 971696
  • Completetx Hospice Hospice, Richardson, TX, CCN 971616
  • Marine Creek Nursing & Rehabilitation Nursing home, Fort Worth, TX, CCN 675779

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L9833TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sciometrix Inc CurrentSince Dec 1, 2023 Accepting new patients
Fort Worth Internal Medicine PA Internal Medicine CurrentSince Jun 20, 2007 Accepting new patients
Hood Medical Group Internal Medicine Past Accepting new patients
West Wharton County Hospital District Past Accepting new patients

Locations

306 S Washington Ave
Ste 600
Royal Oak, MI 48067

650 Saint Louis Ave
Fort Worth, TX 76104
Phone (817) 332-4004

700 Smith St
#61070
Houston, TX 77002
Phone (248) 636-1884

1485 FM 1960 Bypass Rd E
Ste 100
Humble, TX 77338
Phone (281) 964-2100

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Marine Creek Nursing & RehabilitationFort Worth, TX, CCN 675779 Skilled nursing facility Adp of the SNF Sep 1, 2022
Fairbranch Health ServicesMcKinney, TX, CCN E21500 Hospice W-2 Managing Employee Mar 1, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 3

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": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1356308381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 SAINT LOUIS AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043346",
            "telephone_number": "817-386-9818",
            "fax_number": "817-386-9821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "654 SAINT LOUIS AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043358",
            "telephone_number": "817-386-9818",
            "fax_number": "817-386-9821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLATUNJI",
        "first_name": "ADEBOLA",
        "middle_name": "SULAIMAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L9833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167928402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.