Olatola Omobolanle Iyi-Ojo, MD
Individual provider Active NPI Psychiatry Physician · Bradley, IL
NPI 1477074060 · NPPES record last updated Oct 2, 2024
Key facts
- NPI
- 1477074060
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 272831 (MA)
- Practice address
- 400 S Kennedy Dr Ste 300
Bradley, IL 60915-2682 - Phone
- (815) 937-1237
- Fax
- (815) 933-0662
- NPI assigned
- Jul 5, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Riverside Health System
Practice addresses (Care Compare)
400 N Wall St
Suite 402
Kankakee, IL 60901-2963
Phone 81593272008808
Hospital & facility affiliations
- Riverside Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210629000066 | IL | Practitioner - Psychiatry | 0840557807 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverside Health System | Current |
Accepting new patients | |
| Riverside Health System | Psychiatry | Current |
Accepting new patients |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666
400 S Kennedy Dr
Ste 300
Bradley, IL 60915
Phone (815) 935-8040
400 N Wall St
Ste 402
Kankakee, IL 60901
Phone (815) 932-7200
350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500
105 S First St
Wilmington, IL 60481
Phone (815) 476-5210
Interoperability endpoints
- oiyiojo34561@direct.riversidehealthcare.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 272831 | MA | Yes |
Addresses
Primary practice location
400 S Kennedy Dr Ste 300
Bradley, IL 60915-2682
Mailing address
400 S Kennedy Dr Ste 300
Bradley, IL 60915-2682
Phone (815) 937-1237
Other providers in Bradley, IL
- Melissa Hyma
- Illinois Bone and Joint Institute, LLC
- Kathryn Margaret Marie Inczaukskis
- Insight Wellness Center PLLC
- Internal Medicine Associates of Kankakee, LTD
- Jennifer Lyn James
- Jamie J. Boudreau, LTD
- Joshua R Johnson
- Cynthia Jones-Cameron
- Eddie Jones
All providers in Bradley, IL · Psychiatry Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.