Individual provider Active NPI

Olugbenga Adedipe, MD

  • Pediatrics Physician
  • Fort Drum, NY
National Provider Identifier
1720088016
Registry record updated May 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
49996 Issued in GA
Practice address
11050 Mt Belvedere Blvd
Fort Drum, NY 13602-2603
Phone
(315) 772-2778
NPI assigned
Jul 28, 2005
Last updated
May 28, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 49996 GA Primary

Addresses

Primary practice location

11050 Mt Belvedere Blvd
Fort Drum, NY 13602-2603

Mailing address

11050 Mt Belvedere Blvd
Fort Drum, NY 13602-2603

Other identifiers 1

IdentifierTypeStateIssuer
02635095MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME, TX, GA3 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

Enrollment IDStateProvider typePAC IDDetails
I20200723002288 ME Practitioner - Pediatric Medicine 5890846125 Reassigns benefits to 1 organization
I20220622001555 TX Practitioner - Pediatric Medicine 5890846125 Reassigns benefits to 1 organization
I20240618002002 GA Practitioner - Pediatric Medicine 5890846125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
49996GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Houlton Regional Hospital CurrentSince Jun 8, 2020 Accepting new patients
Chickasaw Nation Division of Health Current Accepting new patients
Houlton Regional Hospital CurrentSince Jun 8, 2020 Accepting new patients
Chickasaw Nation Division of Health CurrentSince Oct 6, 2025 Accepting new patients

Locations

20 Hartford St
Houlton, ME 04730
Phone (207) 532-2900

1921 Stonecipher Dr
Ada, OK 74820
Phone (580) 421-4570

2510 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-8181

1438 Hardcastle Blvd
Purcell, OK 73080
Phone (405) 527-4700

Interoperability endpoints

  • Direct secure messaging: adedipe_gbenga@yourcarecommunity.org
  • Direct secure messaging: oadedipe70672@direct.chickasawnationhealth.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779926400000",
    "number": "1720088016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 MT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136022603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 MT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136022603",
            "telephone_number": "315-772-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEDIPE",
        "first_name": "OLUGBENGA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2026-05-28",
        "certification_date": "2026-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "49996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02635095",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Drum, NY

Sources for this page

Verify at the official NPI Registry.