NPIMap

Individual provider Active NPI

Olufemi E Soyinka, MD

  • Family Medicine Physician
  • Bolivar, TN
National Provider Identifier
1568508448
Registry record updated Sep 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
42451 Issued in TN
Practice address
629 Nuckolls Rd
Bolivar, TN 38008-1599
Phone
(731) 658-3388
Fax
(731) 658-4079
NPI assigned
Jan 29, 2007
Last updated
Sep 29, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 42451 TN Primary

Addresses

Primary practice location

629 Nuckolls Rd
Bolivar, TN 38008-1599

Mailing address

629 Nuckolls Rd
Bolivar, TN 38008-1599
Phone (731) 658-3388

Other identifiers 3

IdentifierTypeStateIssuer
4186909OtherTNBCBS
30004592MedicaidTN
P00684728OtherTNRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42451TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bolivar General Hospital, Inc. Past Accepting new patients
Bolivar General Hospital, Inc. Past Accepting new patients
Prism Medical Group, PLC Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317254400000",
    "number": "1568508448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081599",
            "telephone_number": "731-658-3388",
            "fax_number": "731-658-4079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081599",
            "telephone_number": "731-658-3388",
            "fax_number": "731-658-4079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOYINKA",
        "first_name": "OLUFEMI",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2011-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "42451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4186909",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30004592",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00684728",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolivar, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.