NPIMap

Individual provider Active NPI

Julius B Oderinde, M.D .

  • Family Medicine Physician
  • Lithonia, GA
National Provider Identifier
1356437040
Registry record updated Dec 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36658 Issued in GA
Practice address
5403 Sandy LK E
Lithonia, GA 30038-3944
Phone
(478) 714-6901
NPI assigned
Oct 4, 2006
Last updated
Dec 10, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 036658 GA
Family Medicine Physician 207Q00000X 36658 GA Primary

Addresses

Primary practice location

5403 Sandy LK E
Lithonia, GA 30038-3944

Mailing address

5403 Sandy LK E
Lithonia, GA 30038-3944
Phone (478) 714-6901

Other identifiers 1

IdentifierTypeStateIssuer
F69487MedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20040812000003 GA Practitioner - Family PracticePractitioner - Emergency Medicine 0749252484 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southland Hawkinsville Emergency Medical Services, LLCGroup PAC ID 2769600642, 13 clinicians

Practice addresses (Care Compare)

222 Perry Hwy
Hawkinsville, GA 31036-6748
Phone (229) 200-4950

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036658GAMDEmergency Medical Services (Emergency Medicine) Physician
36658GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians of Forsyth, PC CurrentSince Jul 25, 2017 Accepting new patients
Peach Emergency Group LLC CurrentSince Jun 17, 2012 Accepting new patients
Nes Georgia, Inc. Past Accepting new patients
Taylor Regional Emergency Physicians, LLC Past Accepting new patients
Georgia Em-I Medical Services, LLC Past Accepting new patients
United Emergency Services, Inc. Past Accepting new patients
Hospital Authority of Jefferson County and the City of Louisville Past Accepting new patients
Hospital Authority of Jefferson County and the City of Louisville Past Accepting new patients
Inphynet South Broward LLC Family Medicine Past Accepting new patients
Clover Emergency Physicians LLC Past Accepting new patients

Locations

1960 Highway 247
Byron, GA 31008
Phone (478) 654-2000

88 Martin Luther King Jr Dr
Forsyth, GA 31029
Phone (419) 994-2521

Organizations & group practices 13

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.

View all 13

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481328000000",
    "number": "1356437040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5403 SANDY LK E",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300383944",
            "telephone_number": "478-714-6901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5403 SANDY LK E",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300383944",
            "telephone_number": "478-714-6901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODERINDE",
        "first_name": "JULIUS",
        "middle_name": "B",
        "credential": "M.D .",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2016-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "GA",
            "license": "036658",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "36658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "F69487",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lithonia, GA

Sources for this page

Verify at the official NPI Registry.