NPIMap

Individual provider Active NPI

Olabode Olumofin, M.D.

  • Internal Medicine Physician
  • Pine Bluff, AR
National Provider Identifier
1720025513
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E-3124 Issued in AR
Practice address
1801 W 40TH Ave
Suite 1C
Pine Bluff, AR 71603-6940
Phone
(870) 535-4141
Fax
(870) 535-9180
NPI assigned
Jun 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X E3124 AR
Urgent Care Clinic/Center 261QU0200X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X E-3124 AR Primary

Addresses

Primary practice location

1801 W 40TH Ave
Suite 1C
Pine Bluff, AR 71603-6940

Mailing address

1801 W 40TH Ave Ste 1C
Pine Bluff, AR 71603-6956
Phone (870) 535-4141

Other identifiers 1

IdentifierTypeStateIssuer
146619001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20040319001493 AR Practitioner - Internal MedicinePractitioner - Emergency Medicine 9638069727 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Emergency Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1801 W 40TH Ave
Suite 1C
Pine Bluff, AR 71603-6956
Phone (870) 535-4141

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E3124ARMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Firt US Clinic Inc Current Accepting new patients
Jefferson Hospital Association Inc Multi-Specialty CurrentSince Nov 18, 2009 Accepting new patients
Jefferson Hospital Association, Inc Multi-Specialty CurrentSince Nov 18, 2009 Accepting new patients
McGehee Desha County Hospital Multi-Specialty Past Accepting new patients
Stuttgart Regional Medical Center Multi-Specialty Past Accepting new patients
Exigence, LLC Multi-Specialty Past Accepting new patients
Stuttgart Regional Medical Center Multi-Specialty Past Accepting new patients
Phillips Emergency Group LLC Multi-Specialty Past Accepting new patients
Chicot Memorial Hospital Multi-Specialty Past Accepting new patients
Emergency Staffing Solutions Northeast Inc Multi-Specialty Past Accepting new patients
Tyler Emergency Physicians Multi-Specialty Past Accepting new patients

Locations

1015 Unity Rd
Crossett, AR 71635
Phone (870) 364-0590

1641 S Whitehead Dr
Dewitt, AR 72042
Phone (870) 946-2971

811 Highway 65 S
Dumas, AR 71639
Phone (870) 382-4303

2729 S Highway 65 82
Lake Village, AR 71653
Phone (870) 265-5351

1801 W 40th Ave
Ste 1C
Pine Bluff, AR 71603
Phone (501) 663-0005

1614 W 42nd Ave
Pine Bluff, AR 71603
Phone (501) 663-0005

1600 W 40th Ave
Pine Bluff, AR 71603
Phone (870) 541-7100

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DEHICA/Endpoint/DEHICA
  • Direct secure messaging: olabode.olumofin@fusc.eclinicaldirectplus.com

Organizations & group practices 12

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.

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1720025513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W 40TH AVE STE 1C",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036956",
            "telephone_number": "870-535-4141",
            "fax_number": "870-535-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W 40TH AVE",
            "address_2": "SUITE 1C",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036940",
            "telephone_number": "870-535-4141",
            "fax_number": "870-535-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLUMOFIN",
        "first_name": "OLABODE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "E3124",
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-3124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146619001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Bluff, AR

Sources for this page

Verify at the official NPI Registry.