Anthony Adetola Odubanjo, M.D.

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

License

86557 Issued in GA

Practice address

960 Johnson Ferry Rd Ste 500
Atlanta, GA 30342-1630

Phone

(404) 257-0006

Fax

(404) 851-1316

NPI assigned

Jun 26, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in ME, GA, SC3 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 3

Specialty

Internal Medicine

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McLeod Health ClarendonGroup PAC ID 0840582656, 60 clinicians

McLeod Medical Center-DillonGroup PAC ID 3476465311, 13 clinicians

Northside Primary Care Professional Services,LLCGroup PAC ID 9638343924, 313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Hospital, Atlanta, GA, CCN 110161
• McLeod Health Clarendon Hospital, Manning, SC, CCN 420109

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Northside Primary Care Professional Services,LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1922397553
  Medicare reassignment Care Compare group NPD
• McLeod Health Clarendon

  • Certified Registered Nurse Anesthetist
  • Manning, SC
  • NPI 1508218793
  Medicare reassignment Care Compare group
• McLeod Medical Center-Dillon

  • Hospitalist Physician
  • Dillon, SC
  • NPI 1720033988
  Medicare reassignment Care Compare group
• Nes Medical Services of New England Inc

  • Emergency Medicine Physician
  • Bangor, ME
  • NPI 1396401907
  Medicare reassignment NPD
• Sound Physicians of Massachusetts Inc

  • Internal Medicine Physician
  • North Adams, MA
  • NPI 1205164951

  ME

  Medicare reassignment NPD
• Northside Primary Care Professional Services, LLC

  • Urgent Care Clinic/Center
  • Dawsonville, GA
  • NPI 1215369715
  NPD
• Sound Physicians of Massachusetts, Inc

  • Internal Medicine Physician
  • Stoughton, MA
  • NPI 1245784446
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation
• McLeod Health Clarendon

  • Rural Acute Care Hospital
  • Manning, SC
  • NPI 1205284411
  Care Compare affiliation

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

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656720000000",
    "number": "1659786754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD STE 500",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421630",
            "telephone_number": "404-257-0006",
            "fax_number": "404-851-1316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD STE 500",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421630",
            "telephone_number": "404-257-0006",
            "fax_number": "404-851-1316"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Brookdale Plz",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112123139",
            "country_code": "US",
            "telephone_number": "571-201-9753",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3 Glen Cove Dr Ste 3",
            "address_purpose": "LOCATION",
            "city": "Rockport",
            "state": "ME",
            "postal_code": "048564232",
            "country_code": "US",
            "telephone_number": "207-301-5400",
            "fax_number": "207-301-5301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODUBANJO",
        "first_name": "ANTHONY",
        "middle_name": "ADETOLA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-26",
        "last_updated": "2022-07-02",
        "certification_date": "2022-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ME",
            "license": "MD22279",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "GA",
            "license": "86557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jhaelyn Alenzia Odom, N.P.
• Kathryn Folkner Odom, PA-C
• Sidrah Odom
• Amarachi C. Odu, PA-C
• Adanma Oduah, PA
• God-Dowell Oghenevwogaga Odukudu, M.D.
• Amudalat A Odunbaku
• Aso Odus Sr.
• Charles Odusanya
• Adefisayo Oduwole, MD

• Critical Care Medicine (Internal Medicine) Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Critical Care Medicine (Internal Medicine) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.