Omolara Grace Adeniran, MD
Individual provider Active NPI Endocrinology, Diabetes & Metabolism Physician · Brandon, FL
NPI 1609429406 · NPPES record last updated Dec 12, 2024
Key facts
- NPI
- 1609429406
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician 207RE0101X
- License
- ME1683456 (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
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 14
Hospital & facility affiliations 2
Medicare Care Compare profile
- 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 LLC
Practice addresses (Care Compare)
14014 N 46TH St
Suite C
Tampa, FL 33613-4238
Phone (813) 284-2229
Hospital & facility affiliations
- St Josephs Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY, FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240807002053 | NY | Practitioner - Internal Medicine | 4880131986 | Reassigns benefits to 1 organization |
| I20241016002140 | FL | Practitioner - Endocrinology | 4880131986 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 445764 | NY | MD | Internal Medicine Physician |
| ME1683456 | FL | MD | Endocrinology, Diabetes & Metabolism Physician |
Practice roles (6 of 10)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Suffolk Medical, P.C. | Current | Accepting new patients | |
| Southwest Suffolk, P.C | Current |
Accepting new patients | |
| Southwest Suffolk Medical PC | Current |
Accepting new patients | |
| Ohi West Medical Group II LLC | Current |
Accepting new patients | |
| Ohi West Medical Group II LLC | Internal Medicine | Current |
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) 280-7100
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 H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 445764 | NY | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | ME1683456 | FL | Yes |
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
1 Brookdale Plz
Brooklyn, NY 11212-3139
Phone (718) 240-7630
Other practice location 2
450 Clarkson Ave
Brooklyn, NY 11203-2012
Phone (917) 701-3133
Other providers in Brandon, FL
- Alexis Prickett Adams
- Amanda Adams
- Adds01 LLC
- Adeanna Jenae Adebayo
- Adelphie Home Health Care, LLC
- Adept Health & Wellness
- Ibukun Adetula
- Enoch Adjinah
- Adrian Chiropractic PLLC
- Advance Behavior Support LLC
All providers in Brandon, FL · Endocrinology, Diabetes & Metabolism Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.