NPIMap

Individual provider Active NPI

Oladele O. Ajao, MD

  • Internal Medicine Physician
  • Granite City, IL
National Provider Identifier
1700829025
Registry record updated Mar 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036108133 Issued in IL
Practice address
2100 Madison Ave
Granite City, IL 62040-4701
Phone
(618) 452-3301
Fax
(618) 452-3312
NPI assigned
Jun 14, 2006
Last updated
Mar 26, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2021

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 036108133 IL Primary
Infectious Disease Physician 207RI0200X 036108133 IL

Addresses

Primary practice location

2100 Madison Ave
Granite City, IL 62040-4701

Mailing address

2100 Madison Ave
Granite City, IL 62040-4701
Phone (618) 452-3301

Other identifiers 1

IdentifierTypeStateIssuer
036108133MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address oladele.ajao.1@9559.direct.athenahealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20031216000728 IL Practitioner - Internal MedicinePractitioner - Infectious Disease 6002713229 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2166 Madison Ave
Granite City, IL 62040-4700
Phone (618) 332-0953

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036108133ILMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Healthcare Foundation Inc Internal Medicine CurrentSince Sep 2, 2003 Accepting new patients
Southern Illinois Healthcare Foundation Inc Internal Medicine Current Accepting new patients
Southern Illinois Healthcare Foundation Inc CurrentSince Sep 2, 2003 Accepting new patients
MPV New Jersey MD Services PC Past Accepting new patients

Locations

6000 Bond Ave
East Saint Louis, IL 62207
Phone (618) 332-2740

2001 State St
East St Louis, IL 62205
Phone (618) 271-0204

2100 Madison Ave
Granite City, IL 62040
Phone (618) 798-3000

2166 Madison Ave
Granite City, IL 62040
Phone (618) 452-3301

2041 Goose Lake Rd
Sauget, IL 62206

Interoperability endpoints

  • Direct secure messaging: oajao172@yourcarecommunity.org
  • Direct secure messaging: oladele.ajao.1@9559.direct.athenahealth.com

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 6

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1700829025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404701",
            "telephone_number": "618-452-3301",
            "fax_number": "618-452-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 MADISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404701",
            "telephone_number": "618-452-3301",
            "fax_number": "618-452-3312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJAO",
        "first_name": "OLADELE",
        "middle_name": "O.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036108133",
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "IL",
            "license": "036108133",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036108133",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "oladele.ajao.1@9559.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2100 Madison Ave",
            "city": "Granite City",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620404701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Granite City, IL

Sources for this page

Verify at the official NPI Registry.