NPIMap

Individual provider Active NPI

Roland Akinyede, M.D.

  • Internal Medicine Physician
  • Bridgeton, MO
National Provider Identifier
1669531489
Registry record updated Dec 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2001025556 Issued in MO
Practice address
3394 McKelvey Rd
Suite 106
Bridgeton, MO 63044-2531
Phone
(314) 485-5404
Fax
(314) 485-5407
NPI assigned
Dec 7, 2006
Last updated
Dec 23, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2001025556 MO Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 2001025556 MO

Addresses

Primary practice location

3394 McKelvey Rd
Suite 106
Bridgeton, MO 63044-2531

Mailing address

144 Frontenac FRST
Frontenac, MO 63131-3220
Phone (314) 485-5404

Other identifiers 6

IdentifierTypeStateIssuer
193078OtherMOANTHEM BLUE CROSS BLUE SH
266887OtherMOGHP
7857612OtherMOAETNA
9352175OtherMOMERCY HEALTH PLANS
0405742OtherMOUNITED HEALTH CARE
500204706MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041201000642 MO Practitioner - Internal MedicinePractitioner - Geriatric Medicine 6709841760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3394 McKelvey Rd
Suite 106
Bridgeton, MO 63044-2531
Phone (314) 485-5404

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2001025556MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Internal Medicine LLC Internal Medicine CurrentSince Oct 29, 2005 Accepting new patients
Delmar Gardens North Operating, LLC Past Accepting new patients
Bridgeton Operations, LLC Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

3394 McKelvey Rd
Ste 106
Bridgeton, MO 63044
Phone (314) 485-5404

Organizations & group practices 4

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 12

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": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198368000000",
    "number": "1669531489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 FRONTENAC FRST",
            "city": "FRONTENAC",
            "state": "MO",
            "postal_code": "631313220",
            "telephone_number": "314-485-5404",
            "fax_number": "314-485-5407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3394 MCKELVEY RD",
            "address_2": "SUITE 106",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442531",
            "telephone_number": "314-485-5404",
            "fax_number": "314-485-5407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AKINYEDE",
        "first_name": "ROLAND",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-07",
        "last_updated": "2007-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2001025556",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MO",
            "license": "2001025556",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SH",
            "identifier": "193078",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "266887",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7857612",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY HEALTH PLANS",
            "identifier": "9352175",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "0405742",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500204706",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

Verify at the official NPI Registry.