Temidayo Olugbenga Odugbesan, M.D., SA-C

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

6117 Boardwalk Blvd Apt J
Montgomery, AL 36117-2812

Phone

(872) 806-4250

NPI assigned

May 10, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: temidayo.odugbesan.1@9186.direct.athenahealth.com

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

{
    "created_epoch": "1462838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1477909448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 CHESTNUT ST",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061111",
            "telephone_number": "334-440-3061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6117 BOARDWALK BLVD APT J",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361172812",
            "telephone_number": "872-806-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODUGBESAN",
        "first_name": "TEMIDAYO",
        "middle_name": "OLUGBENGA",
        "name_prefix": "Dr.",
        "credential": "M.D., SA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-10",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "238.000495",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Occumed Health & Wellness, LLC
• Occupational Health Centers of Alabama PC
• Candace Odom, LGSW
• Lauren Victoria Odom, MD, MPH
• Shepherd A Odom, MD
• Odyssey Healthcare Operating B LP
• Kimberly Diane Ogletree, D.C.
• Mina Oh
• Harry Eugene Ohme III, DMD
• Felicia Chizomam Oji, DNP, CRNP

• Student in an Organized Health Care Education/Training Program in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Student in an Organized Health Care Education/Training Program in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.