NPIMap

Individual provider Active NPI

Olusola Olasupo Adegoke, MD MPH

  • Family Medicine Physician
  • Apple Valley, MN
National Provider Identifier
1619311586
Registry record updated Mar 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
59639 Issued in MN
Practice address
15290 Pennock LN
Apple Valley, MN 55124-7163
Phone
(952) 853-8800
Fax
(952) 431-6966
NPI assigned
Apr 23, 2013
Last updated
Mar 8, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 59639 MN Primary
Family Medicine Physician 207Q00000X 65487 WI

Addresses

Primary practice location

15290 Pennock LN
Apple Valley, MN 55124-7163

Mailing address

8170 33Rd Ave S # Ms 21110Q
Minneapolis, MN 55425-4516

Other practice location 1

535 Hospital Rd
New Richmond, WI 54017
Phone (715) 243-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151005002194 MN Practitioner - Family Practice 0547578932 Reassigns benefits to 6 organizations
I20160728002643 WI Practitioner - Family Practice 0547578932 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Westfields Hospital IncGroup PAC ID 2264490960, 108 clinicians
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

535 Hospital Rd
New Richmond, WI 54017-1449
Phone (715) 243-2600

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 221-3456

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

927 Churchill W St
Stillwater, MN 55082-6605
Phone (651) 439-5330

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
59639MNMDFamily Medicine Physician
65487WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Croix Regional Medical Center CurrentSince Nov 30, 2021 Accepting new patients
St. Croix Regional Medical Center CurrentSince Nov 30, 2021 Accepting new patients
Hutchinson Health CurrentSince Sep 1, 2023 Accepting new patients
Park Nicollet Clinic Family Medicine CurrentSince Sep 1, 2023 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Sep 6, 2023 Accepting new patients
Westfields Hospital, Inc. CurrentSince Sep 12, 2016 Accepting new patients
Hudson Hospital, Inc. CurrentSince Sep 1, 2023 Accepting new patients
Hudson Hospital, Inc. CurrentSince Sep 1, 2023 Accepting new patients
Healthpartners RC CurrentSince Jan 4, 2026 Accepting new patients
Westfields Hospital, Inc CurrentSince Sep 12, 2016 Accepting new patients
Healthpartners RC CurrentSince May 3, 2023 Accepting new patients
Healthpartners RC CurrentSince May 3, 2023 Accepting new patients
Group Health, Inc. CurrentSince Dec 14, 2015 Accepting new patients
Park Nicollet Clinic Family Medicine CurrentSince Sep 1, 2023 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Sep 6, 2023 Accepting new patients
Westfields Hospital, Inc. Family Medicine CurrentSince Dec 31, 2025 Accepting new patients
Group Health, Inc. CurrentSince Dec 14, 2015 Accepting new patients
Regions Hospital Past Accepting new patients

Locations

1029 Highway 15 S
Hutchinson, MN 55350
Phone (320) 275-3358

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

100 Healthy Way
Olivia, MN 56277
Phone (320) 523-1261

15290 Pennock Ln
Saint Paul, MN 55124
Phone (952) 431-8500

6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246

265 Griffin St E
Amery, WI 54001
Phone (715) 268-0308

405 Stageline Rd
Hudson, WI 54016
Phone (715) 531-6000

535 Hospital Rd
New Richmond, WI 54017
Phone (651) 292-2013

216 S Adams St
St Croix Fls, WI 54024
Phone (715) 483-0426

235 E State St
St Croix Fls, WI 54024
Phone (715) 483-3221

744 E Louisiana St
St Croix Fls, WI 54024
Phone (651) 772-6251

Organizations & group practices 18

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.

View all 18

Hospital & facility affiliations 11

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": "1366675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615161600000",
    "number": "1619311586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15290 PENNOCK LN",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247163",
            "telephone_number": "952-853-8800",
            "fax_number": "952-431-6966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "535 Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "New Richmond",
            "state": "WI",
            "postal_code": "54017",
            "country_code": "US",
            "telephone_number": "715-243-3400",
            "fax_number": "715-246-8980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADEGOKE",
        "first_name": "OLUSOLA",
        "middle_name": "OLASUPO",
        "name_prefix": "Dr.",
        "credential": "MD MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-23",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "59639",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "65487",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, MN

Sources for this page

Verify at the official NPI Registry.