Olufunmilayo Olajumoke Adeyanju, M.D.
Individual provider Active NPI Family Medicine Physician · Bronx, NY
NPI 1689613564 · NPPES record last updated May 2, 2013
Key facts
- NPI
- 1689613564
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- BA9939250 (NY)
- Practice address
- 675 Nereid Ave
Optimum Family Medicine PC
Bronx, NY 10470-1514 - Phone
- (718) 655-7777
- NPI assigned
- Jun 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
675 Nereid Ave
Bronx, NY 10470-1514
Phone (718) 655-7777
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061030000618 | NY | Practitioner - Family Practice | 5991722548 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA079357200 | NJ | MD | Family Medicine Physician |
Practice roles (1 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optimum Family Medicine P.C | Current |
Accepting new patients |
Locations
675 Nereid Ave
Bronx, NY 10470
Phone (646) 441-1399
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/ICJGAA/Endpoint/ICJGAA
- https://fhir4.healow.com/fhir/r4/ICJGAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 25MA079357200 | NJ | |
| Family Medicine Physician | 207Q00000X | BA9939250 | NY | Yes |
Addresses
Primary practice location
675 Nereid Ave
Optimum Family Medicine PC
Bronx, NY 10470-1514
Mailing address
675 Nereid Ave
Bronx, NY 10470-1514
Phone (718) 655-7777
Other providers in Bronx, NY
- Baraqat Adewole
- Hajarat Adewole
- Adekunbi Adewolu
- Victoria Adewunmi
- Iyabo Ajoke Adeyanju
- Dare I Adeyele
- Hannah Adeyemi
- Oluwaseun John Adeyemi
- Serifat Adeyemi
- Tokunbo O Adeyemi
All providers in Bronx, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.