Mercy Adeola Odueyungbo, M.D.,

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

4301108524 Issued in MI

Practice address

1500 Sandpoint Rd
Munising, MI 49862

Phone

(906) 362-7546

Fax

(413) 269-8079

NPI assigned

Jun 28, 2010

Last updated

Oct 31, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Dermatology

Education

Indiana University School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Concierge Dermatology and Skin Surgery CenterGroup PAC ID 8123377405, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

84.51 of 100Reported as group

Quality

69.02

Improvement activities

40

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Concierge Dermatology & Skin Surgery Center

  • MOHS-Micrographic Surgery Physician
  • Hancock, MI
  • NPI 1417442898
  Medicare reassignment Care Compare group NPD Authorized official
• St. Francis Hospital

  dba OFSMG - Women's Center

  • Obstetrics & Gynecology Physician
  • Escanaba, MI
  • NPI 1700828837
  Medicare reassignment
• St Francis Hospital

  dba St. Francis Professional Services

  • Anatomic Pathology & Clinical Pathology Physician
  • Escanaba, MI
  • NPI 1932206455
  NPD
• St. Francis Hospital

  dba OSFMG Escanaba Gladstone Powers

  • Family Medicine Physician
  • Escanaba, MI
  • NPI 1629011622
  NPD

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

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540944000000",
    "number": "1801107552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 S LAKESHORE BLVD UNIT 34",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498554631",
            "telephone_number": "906-362-7546",
            "fax_number": "413-362-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SANDPOINT RD",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "49862",
            "telephone_number": "906-362-7546",
            "fax_number": "413-269-8079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODUEYUNGBO",
        "first_name": "MERCY",
        "middle_name": "ADEOLA",
        "name_prefix": "Dr.",
        "credential": "M.D.,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-28",
        "last_updated": "2018-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MI",
            "license": "4301108524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Munising Memorial Hospital Association (Bay Care Medical Center Specialty Clinic)
• Munising Memorial Hospital Association (Bay Care Medical Center)
• Munising Memorial Hospital Association (Munising Memorial Hospital)
• Munising Opco, LLC (Medilodge of Munising)
• Renae Nelson
• Kurt Richard Olson, M.D.
• Mark Walter Olson, M.D.
• Ryan Kurt Olson, CNP
• Heather Palmer
• Pathways Community Mental Health

• MOHS-Micrographic Surgery Physician in Munising, MI
• Providers in Munising, MI by specialty
• MOHS-Micrographic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2018; 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.