Individual provider Active NPI

Niyi O Odewade

  • Student in an Organized Health Care Education/Training Program
  • Boston, MA
National Provider Identifier
1639811722
Registry record updated Dec 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
75 Francis St
Boston, MA 02115-6106
Phone
(617) 732-5500
NPI assigned
Apr 10, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

75 Francis St
Boston, MA 02115-6106

Mailing address

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20251110002247 MA Practitioner - General Surgery 1153811856 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Harvard Medical School, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11 Conway St
Suite 3
Roslindale, MA 02131-1605

126 Kinnaird St
Cambridge, MA 02139-2992

25044 Peachland Ave
Suite 110
Newhall, CA 91321-2577

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Izuchukwu Okpara MD Ma, PLLC CurrentSince Oct 30, 2025 Accepting new patients

Locations

25044 Peachland Ave
Ste 110
Santa Clarita, CA 91321

370 Main St
Fl 11
Worcester, MA 01608
Phone (203) 568-6065

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1649548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703376000000",
    "number": "1639811722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-732-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156106",
            "telephone_number": "617-732-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODEWADE",
        "first_name": "NIYI",
        "middle_name": "O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-10",
        "last_updated": "2023-12-24",
        "certification_date": "2023-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.