Olufunso W Odunukan, MD

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

65997 Issued in AZ

Practice address

1001 Willow Creek Rd Ste 2200
Prescott, AZ 86301-1614

Phone

(928) 445-6025

Fax

(928) 778-3026

NPI assigned

Jul 30, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA, AZ2 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 2

Specialty

Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Yavapai Regional Medical Center Physician Care LLCGroup PAC ID 5294898987, 123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Yavapai Regional Medical Center Hospital, Prescott, AZ, CCN 030012

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Yavapai Regional Medical Center Physician Care LLC

  dba Yavapai Regional Medical Center Physician Care

  • Cardiovascular Disease Physician
  • Prescott, AZ
  • NPI 1255582003
  Medicare reassignment Care Compare group NPD
• Hamilton Physician Group Inc

  • Cardiovascular Disease Physician
  • Dalton, GA
  • NPI 1235455569
  Medicare reassignment NPD
• Gwinnett Physician Group, LLC

  • Internal Medicine Physician
  • Lawrenceville, GA
  • NPI 1578574661
  Medicare reassignment
• Yavapai Regional Medical Center Physician Care LLC

  dba Yavapai Regional Medical Center Physician Care

  • Internal Medicine Physician
  • Prescott, AZ
  • NPI 1083940399
  NPD
• Yavapai Regional Medical Center Physician Care LLC

  dba Yavapai Regional Medical Center Physician Care

  • Cardiovascular Disease Physician
  • Prescott, AZ
  • NPI 1528394830
  NPD
• Prescott Gastroenterology

  • Gastroenterology Physician
  • Prescott, AZ
  • NPI 1720110984
  NPD (past)
• Gwinnett Medical Group, Inc

  • General Practice Physician
  • Lawrenceville, GA
  • NPI 1780747469

  Internal Medicine

  NPD (past)

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

• Yavapai Community Hospital Association

  dba Yavapai Regional Medical Center

  • General Acute Care Hospital
  • Prescott, AZ
  • NPI 1902897820
  Care Compare affiliation

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

{
    "created_epoch": "1248912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1780815308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "928-759-5874",
            "fax_number": "928-458-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 WILLOW CREEK RD STE 2200",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011614",
            "telephone_number": "928-445-6025",
            "fax_number": "928-778-3026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5380 S Rainbow Blvd Ste 226",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891181879",
            "country_code": "US",
            "telephone_number": "702-260-0022",
            "fax_number": "702-260-0200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODUNUKAN",
        "first_name": "OLUFUNSO",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-30",
        "last_updated": "2023-03-07",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NV",
            "license": "20655",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "GA",
            "license": "80736",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "SD",
            "license": "8441",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "AZ",
            "license": "65997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250011662",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA MEDICAL BOARD",
            "identifier": "65997",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Joseph Oconnor, MD
• Martha Louise Odegaard, L.AC., O.M.D.
• Christina Odell, LAC
• April Renae Odorfer, FNP
• Catherine Odorfer, PT, DPT
• Kristi Ogden, LMY
• Mary Ohm, ACNP- BC
• Shirley Ohn, M.D.
• Catherine C. Ohsiek-Lesnick, M.D.
• Gregory Oldani, M.D.

• Interventional Cardiology Physician in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Interventional Cardiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.