NPIMap

Individual provider Active NPI

Abodunrin Sulaimon Olasubomi Badejo, M.D.

  • Gastroenterology Physician
  • Mountain Home, AR
National Provider Identifier
1831157551
Registry record updated Apr 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
E3359 Issued in AR
Practice address
228 Bucher Dr
Mountain Home, AR 72653-3400
Phone
(870) 425-4416
Fax
(870) 425-8615
NPI assigned
May 2, 2006
Last updated
Apr 25, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X E3359 AR Primary

Addresses

Primary practice location

228 Bucher Dr
Mountain Home, AR 72653-3400

Mailing address

228 Bucher Dr
Mountain Home, AR 72653-3400
Phone (870) 425-4416

Other identifiers 2

IdentifierTypeStateIssuer
152961001MedicaidAR
06-1833974OtherTAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20051219000474 AR Practitioner - Internal MedicinePractitioner - Gastroenterology 9830110824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Gastroenterology
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

228 Bucher Dr
Mountain Home, AR 72653-3400
Phone (870) 425-4416

624 Hospital Dr
Mountain Home, AR 72653-2955
Phone (870) 508-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy213
Upper gastrointestinal (GI) endoscopy for acid reflux323

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E3359ARMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baxter County Regional Hospital Inc CurrentSince Dec 19, 2016 Accepting new patients
Baxter County Regional Hospital, Inc CurrentSince Dec 19, 2016 Accepting new patients
Baxter County Regional Hospital Inc Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

228 Bucher Dr
Mountain Home, AR 72653
Phone (870) 425-4416

624 Hospital Dr
Mountain Home, AR 72653
Phone (870) 424-1000

628 Hospital Dr
Ste A
Mountain Home, AR 72653
Phone (501) 425-4402

Interoperability endpoints

  • Direct secure messaging: abodunrin.badejo@bhcawp.eclinicaldirectplus.com

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493078400000",
    "number": "1831157551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 BUCHER DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726533400",
            "telephone_number": "870-425-4416",
            "fax_number": "870-425-8615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 BUCHER DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726533400",
            "telephone_number": "870-425-4416",
            "fax_number": "870-425-8615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BADEJO",
        "first_name": "ABODUNRIN",
        "middle_name": "SULAIMON OLASUBOMI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2017-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AR",
            "license": "E3359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152961001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "06-1833974",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home, AR

Sources for this page

Verify at the official NPI Registry.