NPIMap

Individual provider Active NPI

Adeniyi O Odugbesan, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Lawrenceville, GA
National Provider Identifier
1528175601
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
33660 Issued in GA
Practice address
771 Old Norcross Rd
Suite 200
Lawrenceville, GA 30046-4386
Phone
(770) 339-1387
Fax
(770) 962-7868
NPI assigned
Aug 24, 2006
Last updated
Dec 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 33660 GA Primary

Addresses

Primary practice location

771 Old Norcross Rd
Suite 200
Lawrenceville, GA 30046-4386

Mailing address

771 Old Norcross Rd
Suite 200
Lawrenceville, GA 30046-4386
Phone (770) 339-1387

Other names 1

  • Ola Odugbesan Other name

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
I20100122000480 GA Practitioner - Endocrinology 3577604784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Atlanta Endocrinology and Diabetes, PCGroup PAC ID 7618965146, 11 clinicians

Practice addresses (Care Compare)

771 Old Norcross Rd
Suite 200
Lawrenceville, GA 30046-4980
Phone 7703391387229

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.95 of 100Reported as individual
Quality
78.71
Improvement activities
40
Cost
78.23

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33660GAMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Atlanta Endocrinology and Diabetes, PC Endocrinology, Diabetes & Metabolism CurrentSince Jan 1, 1994 Accepting new patients
Openloop Healthcare Partners PC PastSince Jan 1, 1994 Accepting new patients
North Atlanta Scan Associates Inc Past Accepting new patients

Locations

758 Old Norcross Rd
Ste 175
Lawrenceville, GA 30046
Phone (770) 339-1387

771 Old Norcross Rd
Ste 200
Lawrenceville, GA 30046
Phone (770) 339-1387

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.400261

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1528175601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "771 OLD NORCROSS RD",
            "address_2": "SUITE 200",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464386",
            "telephone_number": "770-339-1387",
            "fax_number": "770-962-7868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 OLD NORCROSS RD",
            "address_2": "SUITE 200",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464386",
            "telephone_number": "770-339-1387",
            "fax_number": "770-962-7868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODUGBESAN",
        "first_name": "ADENIYI",
        "middle_name": "O",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "GA",
            "license": "33660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OLA",
            "last_name": "ODUGBESAN",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.