Individual provider Active NPI

Olaniyi Fadeyi, MD

  • Internal Medicine Physician
  • Anaheim, CA
National Provider Identifier
1487275194
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A191379 Issued in CA
Practice address
3033 W Orange Ave
Anaheim, CA 92804-3183
Phone
(832) 870-2089
NPI assigned
May 4, 2020
Last updated
Jul 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X A191379 CA Primary

Addresses

Primary practice location

3033 W Orange Ave
Anaheim, CA 92804-3183

Mailing address

3102 Haine Dr Apt 212
Harlingen, TX 78550-0800
Phone (832) 870-2089

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20240715001393 CA Practitioner - Internal Medicine 3274078258 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
24 On Physicians of California PCGroup PAC ID 7012228992, 58 clinicians

Practice addresses (Care Compare)

1415 Ross Ave
El Centro, CA 92243-4306
Phone (760) 339-4045

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A191379CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
24 On Physicians of California, PC CurrentSince Oct 23, 2024 Accepting new patients
Inpatient Specialists of California, PC Internal Medicine CurrentSince Jun 1, 2024 Accepting new patients

Locations

207 W Legion Rd
Brawley, CA 92227
Phone (760) 351-3333

1415 Ross Ave
El Centro, CA 92243
Phone (760) 339-4045

465 W Putnam Ave
Porterville, CA 93257
Phone (559) 784-8886

2550 Sister Mary Columba Dr
Red Bluff, CA 96080
Phone (530) 529-8000

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1588550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1487275194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3102 HAINE DR APT 212",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785500800",
            "telephone_number": "832-870-2089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 W ORANGE AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043183",
            "telephone_number": "832-870-2089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADEYI",
        "first_name": "OLANIYI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-04",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A191379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.