Samuel Olaniyi Bada, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD34358 Issued in TN

Practice address

1673 N Royal St
Jackson, TN 38301-3607

Phone

(731) 265-1997

Fax

(731) 265-0511

NPI assigned

May 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

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 1

Specialty

Internal MedicineAlso: Emergency Medicine

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ultimate Health Clinic PCGroup PAC ID 8022194703, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• NHC Homecare Milan Home health agency, Milan, TN, CCN 447152
• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002
• Pine Meadows Health Care Nursing home, Bolivar, TN, CCN 445232
• Mission Convalescent Home Nursing home, Jackson, TN, CCN 445447

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GBCFAA

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.

• Ultimate Health Clinic PC

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1669567707

  Internal Medicine, TN

  Medicare reassignment Care Compare group NPD Authorized official
• Concord Medical Group of Kentucky PLLC

  • Emergency Medicine Physician
  • Hardinsburg, KY
  • NPI 1346746385

  TN

  Medicare reassignment NPD
• Concord Medical Group PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1083630610

  TN

  Medicare reassignment NPD
• South Central Physicians PLLC

  • Hospitalist Physician
  • Lubbock, TX
  • NPI 1427611854

  TN

  Medicare reassignment NPD
• Ultimate Health Clinic North

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1013643998

  Internal Medicine

  NPD Authorized official
• Concord Medical Group of Texas PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1750790762
  NPD
• Bolivar General Hospital, Inc.

  • General Acute Care Hospital
  • Bolivar, TN
  • NPI 1174545446
  NPD (past)
• Bolivar General Hospital, Inc.

  • Critical Access Hospital
  • Bolivar, TN
  • NPI 1518957950
  NPD (past)
• Bolivar Operator LLC

  • Skilled Nursing Facility
  • Bolivar, TN
  • NPI 1316018286
  NPD (past)
• Cah Acquisition Company 11 LLC

  • Surgery Physician
  • Ripley, TN
  • NPI 1588911986
  NPD (past)
• Decatur County General Hospital

  • General Acute Care Hospital
  • Parsons, TN
  • NPI 1104804566
  NPD (past)
• Nes Tennessee, Inc.

  • Emergency Medicine Physician
  • Shelbyville, TN
  • NPI 1427039858
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bolivar Operator LLC

  • Skilled Nursing Facility
  • Bolivar, TN
  • NPI 1316018286

  Nursing home

  Care Compare affiliation
• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428

  Hospital

  Care Compare affiliation
• NHC-Op LP

  • Home Health Agency
  • Milan, TN
  • NPI 1124043914
  Care Compare affiliation
• Old Folks Mission Center,Inc.

  • Skilled Nursing Facility
  • Jackson, TN
  • NPI 1689603755

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349136000000",
    "number": "1770530586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1673 N ROYAL ST",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013607",
            "telephone_number": "731-265-1997",
            "fax_number": "731-265-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1673 N ROYAL ST",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013607",
            "telephone_number": "731-265-1997",
            "fax_number": "731-265-0511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BADA",
        "first_name": "SAMUEL",
        "middle_name": "OLANIYI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2012-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD34358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3833490",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3858256",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Scarlet Ann Bailey, PTA

• All providers in Jackson, TN
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; 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.

Verify at the official NPI Registry.