Individual provider Active NPI

Omolara Grace Adeniran, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Brandon, FL
National Provider Identifier
1609429406
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
ME1683456 Issued in FL
Practice address
1721 Brandon Main St Ste D
Brandon, FL 33511-5018
Phone
(813) 977-2020
Fax
(813) 355-5010
NPI assigned
Jul 20, 2019
Last updated
Dec 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 445764 NY
Student in an Organized Health Care Education/Training Program 390200000X
Endocrinology, Diabetes & Metabolism Physician 207RE0101X ME1683456 FL Primary

Addresses

Primary practice location

1721 Brandon Main St Ste D
Brandon, FL 33511-5018

Mailing address

38135 Market Square Dr
Zephyrhills, FL 33542-7505
Phone (352) 567-0188

Other practice location 1

450 Clarkson Ave
Brooklyn, NY 11203-2012
Phone (917) 701-3133

Other practice location 2

1 Brookdale Plz
Brooklyn, NY 11212-3139
Phone (718) 240-7630

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240807002053 NY Practitioner - Internal Medicine 4880131986 Reassigns benefits to 1 organization
I20241016002140 FL Practitioner - Endocrinology 4880131986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ohi West Medical Group II LLCGroup PAC ID 0648631192, 407 clinicians

Practice addresses (Care Compare)

14014 N 46TH St
Suite C
Tampa, FL 33613-4238
Phone (813) 284-2229

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
445764NYMDInternal Medicine Physician
ME1683456FLMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Suffolk Medical, P.C. Current Accepting new patients
Ohi West Medical Group II LLC CurrentSince Dec 1, 2024 Accepting new patients
Southwest Suffolk, P.C CurrentSince Aug 1, 2024 Accepting new patients
Southwest Suffolk Medical PC CurrentSince Aug 1, 2024 Accepting new patients
Ohi West Medical Group II LLC Internal Medicine CurrentSince Dec 1, 2024 Accepting new patients
Ohi West Medical Group II LLC Past Accepting new patients

Locations

1721 Brandon Main St
Ste C
Brandon, FL 33511
Phone (813) 973-1304

1721 Brandon Main St
Ste D
Brandon, FL 33511
Phone (813) 284-2220

14014 N 46th St
Ste C
Tampa, FL 33613
Phone (813) 284-2229

38135 Market Square Dr
Zephyrhills, FL 33542
Phone (352) 567-0188

38135 Market Square Dr
Ste 101
Zephyrhills, FL 33542
Phone (813) 788-7651

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 6

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": "1563580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1609429406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38135 MARKET SQUARE DR",
            "city": "ZEPHYRHILLS",
            "state": "FL",
            "postal_code": "335427505",
            "telephone_number": "352-567-0188",
            "fax_number": "813-355-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 BRANDON MAIN ST STE D",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115018",
            "telephone_number": "813-977-2020",
            "fax_number": "813-355-5010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 Clarkson Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112032012",
            "country_code": "US",
            "telephone_number": "917-701-3133",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Brookdale Plz",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112123139",
            "country_code": "US",
            "telephone_number": "718-240-7630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADENIRAN",
        "first_name": "OMOLARA",
        "middle_name": "GRACE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-20",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "445764",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "FL",
            "license": "ME1683456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.