Individual provider Active NPI

Iyunoluwa Agboola, M.D

  • Family Medicine Physician
  • San Antonio, TX
National Provider Identifier
1659710044
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
Q9102 Issued in TX
Practice address
2121 SW 36TH St
San Antonio, TX 78237-3360
Phone
(210) 358-5100
NPI assigned
Jun 18, 2013
Last updated
May 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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 MT203859 PA
Family Medicine Physician 207Q00000X Q9102 TX Primary

Addresses

Primary practice location

2121 SW 36TH St
San Antonio, TX 78237-3360

Mailing address

PO Box 734812
Dallas, TX 75373-0001
Phone (210) 358-9500

Other practice location 1

5215 Centre Ave
upmc shadyside family health center
Pittsburgh, PA 15232-1303
Phone (412) 623-2817

Other practice location 2

302 W Rector St
San Antonio, TX 78216-5718
Phone (210) 358-0800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address iagboola24000@uhssa.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20161022000015 TX Practitioner - Family Practice 1658697404 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Howard University College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Medicine AssociatesGroup PAC ID 7719979509, 590 clinicians

Practice addresses (Care Compare)

2121 SW 36TH St
San Antonio, TX 78237-3360
Phone (210) 358-5100

903 W Martin St
Ms 49 2
San Antonio, TX 78207-3110
Phone (210) 358-3441

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.65 of 100Reported as group
Quality
83.62
Promoting interoperability
100
Improvement activities
40
Cost
78.03

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT203859PAMDFamily Medicine Physician
Q9102TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medicine Associates Family Medicine CurrentSince Aug 15, 2016 Accepting new patients
Pain Management Specialists CurrentSince Feb 7, 2021 Accepting new patients

Locations

2121 SW 36th St
San Antonio, TX 78237
Phone (210) 358-5100

302 W Rector St
San Antonio, TX 78216
Phone (210) 358-0800

903 W Martin St
#492
San Antonio, TX 78207
Phone (210) 358-3441

Organizations & group practices 2

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 1

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": "1371513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1659710044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 734812",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753730001",
            "telephone_number": "210-358-9500",
            "fax_number": "210-358-9183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 SW 36TH ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782373360",
            "telephone_number": "210-358-5100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5215 Centre Ave",
            "address_2": "upmc shadyside family health center",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152321303",
            "country_code": "US",
            "telephone_number": "412-623-2817",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "302 W Rector St",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782165718",
            "country_code": "US",
            "telephone_number": "210-358-0800",
            "fax_number": "210-358-0850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGBOOLA",
        "first_name": "IYUNOLUWA",
        "name_prefix": "Ms.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-18",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MT203859",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "Q9102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iagboola24000@uhssa.direct-ci.com",
            "affiliation": "N",
            "address_1": "302 W Rector St",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782165718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.