NPIMap

Individual provider Active NPI

Henry A Odukomaiya, M.D.

  • Family Medicine Physician
  • Tampa, FL
National Provider Identifier
1740254184
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME68789 Issued in FL
Practice address
5331 Primrose Lake Cir Ste 112
Tampa, FL 33647-3764
Phone
(813) 651-1085
NPI assigned
Feb 14, 2006
Last updated
May 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME68789 FL Primary

Addresses

Primary practice location

5331 Primrose Lake Cir Ste 112
Tampa, FL 33647-3764

Mailing address

PO Box 47535
Tampa, FL 33646-0113
Phone (813) 755-0006

Other identifiers 1

IdentifierTypeStateIssuer
024433500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20041101000230 FL Practitioner - Family Practice 3577525716 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bestcare Physician Services LLCGroup PAC ID 1456690320, 14 clinicians

Practice addresses (Care Compare)

5331 Primrose Lake Cir
Suite 112
Tampa, FL 33647-3764
Phone (813) 517-4629

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.35 of 100Reported as group
Quality
93.89
Improvement activities
40
Cost
29.3

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa General Hospital Current Accepting new patients
Inpatient Consultants of Florida, Inc CurrentSince Jul 19, 2013 Accepting new patients
Inpatient Consultants of Florida Inc CurrentSince Jul 19, 2013 Accepting new patients
Bestcare Physician Services LLC. CurrentSince Feb 1, 2020 Accepting new patients

Locations

1414 59th St S
Gulfport, FL 33707
Phone (727) 344-4608

350 7th St N
Naples, FL 34102
Phone (239) 436-5000

2029 Professional Center Dr
Orange Park, FL 32073
Phone (904) 264-8621

6000 49th St N
St Petersburg, FL 33709
Phone (727) 521-4411

1203 E 22nd Ave
Tampa, FL 33605
Phone (813) 229-6901

13806 N 46th St
Tampa, FL 33613
Phone (813) 345-5616

1514 E Chelsea St
Tampa, FL 33610
Phone (813) 238-6406

3030 W Bearss Ave
Tampa, FL 33618
Phone (813) 932-2222

5331 Primrose Lake Cir
Ste 112
Tampa, FL 33647
Phone (813) 316-6500

Interoperability endpoints

  • Direct secure messaging: hodukomaiya8267@direct.tgh.org
  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

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 7

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": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622073600000",
    "number": "1740254184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47535",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336460113",
            "telephone_number": "813-755-0006",
            "fax_number": "813-986-2731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5331 PRIMROSE LAKE CIR STE 112",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336473764",
            "telephone_number": "813-651-1085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODUKOMAIYA",
        "first_name": "HENRY",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME68789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024433500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.