Ayodeji Adetayo Ayeni, M.D
Individual provider Active NPI Pediatrics Physician · Shafter, CA
NPI 1831194331 · NPPES record last updated Oct 3, 2016
Key facts
- NPI
- 1831194331
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- A85436 (CA)
- Practice address
- 501 Munzer St Ste C
Shafter, CA 93263-2042 - Phone
- (661) 630-5274
- Fax
- (661) 630-5290
- NPI assigned
- Jun 20, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Owned or controlled facilities with NPI records 3
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Shafter Urgent Care
Practice addresses (Care Compare)
501 Munzer St
Suite a
Shafter, CA 93263-2052
Phone (661) 429-2739
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Shafter Pediatrics |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Corporate Officer (100%) Corporate Director (100%) W-2 Managing Employee (100%) |
May 4, 2015 May 4, 2015 May 15, 2015 Sep 19, 2016 |
| Shafter Urgent Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) Corporate Officer (50%) Corporate Director (50%) |
Jan 1, 2016 Jan 1, 2016 Jan 1, 2016 |
| Elmo Pediatrics & Family Walk-in Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | May 4, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050512000942 | CA | Practitioner - Pediatric Medicine | 9739120494 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles (8 of 9)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shafter Urgent Care | Current |
Accepting new patients | |
| Shafter Pediatrics | Pediatrics | Current |
Accepting new patients |
| Shafter Pediatrics | Pediatrics | Current |
Accepting new patients |
| Bakersfield Memorial Hospital | Past | Accepting new patients | |
| San Joaquin Community Hospital | Past | Accepting new patients | |
| Omni Family Health | Past | Accepting new patients | |
| Dignity Health | Past | Accepting new patients | |
| Omni Family Health | Past | Accepting new patients |
Locations
221 Elmo Hwy
#100
Mc Farland, CA 93250
Phone (661) 720-1883
501 Munzer St
Ste C
Shafter, CA 93263
Phone (661) 364-5244
501 Munzer St
Ste A
Shafter, CA 93263
Phone (661) 429-2739
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A85436 | CA | Yes |
Addresses
Primary practice location
501 Munzer St Ste C
Shafter, CA 93263-2042
Mailing address
PO Box 22694
Bakersfield, CA 93390-2694
Phone (661) 364-5244
Other providers in Shafter, CA
- Vanessa Alba
- Brittany Alford
- Nathan Carl Allen
- Art of Serenity Inc
- Aviation Medi Group Inc
- Shike Ayeni
- Mario Bagallon
- Amanda Bilik
- Brighter Day Strtp
- Brighter Days Ahead LLC
All providers in Shafter, CA · Pediatrics Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.