NPIMap

Individual provider Active NPI

Bamidele Ogunleye, M.D.

  • Obstetrics & Gynecology Physician
  • Bloomington, IL
National Provider Identifier
1831209584
Registry record updated Apr 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036111892 Issued in IL
Practice address
2111 East Oakland Ave
Ste B
Bloomington, IL 61701-5783
Phone
(309) 808-3068
Fax
(309) 808-3072
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 036111892 IL Primary

Addresses

Primary practice location

2111 East Oakland Ave
Ste B
Bloomington, IL 61701-5783

Mailing address

2111 East Oakland
Ste B
Bloomington, IL 61701-5783
Phone (309) 808-3068

Other identifiers 2

IdentifierTypeStateIssuer
IL7587OtherILMECIARE PTAN GROUP
IL7587001OtherILMEDICARE PTAN INDIVIDUAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20040929000584 IL Practitioner - Obstetrics/GynecologyPractitioner - Other (Physician) 5395714067 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Womens Healthcare SCGroup PAC ID 9133379340, 8 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

2111 E Oakland Ave
Suite B
Bloomington, IL 61701-5783
Phone (309) 808-3068

2500 W Reynolds St
Suite 212
Pontiac, IL 61764-9774
Phone (815) 842-3567

Hospital & facility affiliations

  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162
  • Saint James Hospital Hospital, Pontiac, IL, CCN 140161
  • Carle Bromenn Medical Center Hospital, Normal, IL, CCN 140127
  • Hopedale Hospital Hospital, Hopedale, IL, CCN 141330

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10
Removal of the uterus18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036111892ILMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Sep 11, 2023 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

1701 E College Ave
Bloomington, IL 61704
Phone (309) 664-3000

2111 E Oakland Ave
Ste B
Bloomington, IL 61701
Phone (309) 531-3012

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

2500 W Reynolds St
#212
Pontiac, IL 61764
Phone (815) 842-3567

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365638400000",
    "number": "1831209584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 EAST OAKLAND",
            "address_2": "STE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617015783",
            "telephone_number": "309-808-3068",
            "fax_number": "309-808-3072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 EAST OAKLAND AVE",
            "address_2": "STE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617015783",
            "telephone_number": "309-808-3068",
            "fax_number": "309-808-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGUNLEYE",
        "first_name": "BAMIDELE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036111892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MECIARE PTAN GROUP",
            "identifier": "IL7587",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN INDIVIDUAL",
            "identifier": "IL7587001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.