Active NPI
Adedapo M Oduwole, MD
- Psychiatry Physician
- Myrtle Beach, SC
National Provider Identifier
1720139645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 31507
- Practice address
- 1203 48TH Ave N
202
Myrtle Beach, SC 29577-5425 - Phone
- (843) 449-2576
- Fax
- (843) 449-6851
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 43425 | WI | |
| Psychiatry Physician | 2084P0800X | 31507 | SC | Primary |
Addresses
Primary practice location
1203 48TH Ave N
202
Myrtle Beach, SC 29577-5425
Mailing address
1203 48TH Ave N
202
Myrtle Beach, SC 29577-5425
Phone (843) 449-2576
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31507 | Medicaid | SC | |
| 34116200 | Medicaid | WI |
Other names 1
- Oduwole M Adedaop
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC, NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091110000244 | SC | Practitioner - Psychiatry | 2062550114 | Reassigns benefits to 1 organization |
| I20260107002764 | NY | Practitioner - Psychiatry | 2062550114 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- Other, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Mofdaps and Company
Practice addresses (Care Compare)
1203 48TH Ave N
Suite 202
Myrtle Beach, SC 29577-5425
Phone (843) 449-2576
Hospital & facility affiliations
- McLeod Loris Hospital
- Conway Medical Center
- Grand Strand Regional Medical Center
- Tidelands Waccamaw Community Hospital
- McLeod Medical Center - Dillon
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.29 of 100
- Quality
- 80.38
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31507 | SC | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mofdaps and Company | Psychiatry | Current | Accepting new patients |
| Multiviz Medical Services PC | Current | Accepting new patients | |
| HHC South Carolina Inc | Past | Accepting new patients | |
| Abiola Familusi | Past | Accepting new patients | |
| University Group Medical Associates, P.C | Psychiatry | Past | Accepting new patients |
Locations
529 Beach 20th St
Far Rockaway, NY 11691
Phone (516) 770-5712
300 Garden City Plz
Ste 418
Garden City, NY 11530
Phone (516) 481-7050
80 N Franklin St
Hempstead, NY 11550
Phone (516) 481-6433
152 Waccamaw Medical Park Dr
Conway, SC 29526
Phone (843) 347-8871
1203 48th Ave N
Ste 202
Myrtle Beach, SC 29577
Phone (843) 449-2576
Interoperability endpoints
- aoduwole24946@directmcleodehealth.org
Organizations & group practices 5
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.
-
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- Conway, SC
- NPI 1194826081
-
- Internal Medicine Physician
- Far Rockaway, NY
- NPI 1295958445
-
- Diagnostic Radiology Physician
- Brooklyn, NY
- NPI 1285683102
Psychiatry
Hospital & facility affiliations 17
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": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395360000000",
"number": "1720139645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1203 48TH AVE N",
"address_2": "202",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295775425",
"telephone_number": "843-449-2576",
"fax_number": "843-449-6851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1203 48TH AVE N",
"address_2": "202",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295775425",
"telephone_number": "843-449-2576",
"fax_number": "843-449-6851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODUWOLE",
"first_name": "ADEDAPO",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2014-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WI",
"license": "43425",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "SC",
"license": "31507",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31507",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "34116200",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ODUWOLE",
"last_name": "ADEDAOP",
"middle_name": "M",
"credential": "MD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.