Individual provider Active NPI

Taiwo Iyabo Adebayo, N.P

  • Primary Care Nurse Practitioner
  • Peebles, OH
National Provider Identifier
1366100554
Registry record updated Dec 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
A.P.R.N.0030333 Issued in OH
Practice address
154 Elliott Ave
Peebles, OH 45660-1028
Phone
(937) 587-2618
NPI assigned
Dec 4, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X A.P.R.N.0030333 OH Primary

Addresses

Primary practice location

154 Elliott Ave
Peebles, OH 45660-1028

Mailing address

154 Elliott Ave
Peebles, OH 45660-1028
Phone (937) 587-2618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220404001449 OH Practitioner - Nurse Practitioner 2264828052 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A.P.R.N.0030333OHMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
CG Medical Associates Inc CurrentSince Feb 1, 2022 Accepting new patients
On Time Urgent Care LLC CurrentSince Oct 12, 2022 Accepting new patients
Theoria Medical CurrentSince Jul 15, 2024 Accepting new patients

Locations

7300 Beechmont Ave
Cincinnati, OH 45230
Phone (513) 232-9100

441 Norton Rd
Columbus, OH 43228
Phone (614) 794-8800

2977 W Broad St
Columbus, OH 43204
Phone (614) 275-3031

5700 Karl Rd
Columbus, OH 43229
Phone (614) 846-5420

1030 High St
Worthington, OH 43085
Phone (614) 876-7356

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": "1638576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638576000000",
    "number": "1366100554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 ELLIOTT AVE",
            "city": "PEEBLES",
            "state": "OH",
            "postal_code": "456601028",
            "telephone_number": "937-587-2618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 ELLIOTT AVE",
            "city": "PEEBLES",
            "state": "OH",
            "postal_code": "456601028",
            "telephone_number": "937-587-2618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEBAYO",
        "first_name": "TAIWO",
        "middle_name": "IYABO",
        "credential": "N.P",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-04",
        "last_updated": "2021-12-04",
        "certification_date": "2021-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OH",
            "license": "A.P.R.N.0030333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peebles, OH

Sources for this page

Verify at the official NPI Registry.