Individual provider Active NPI

Bola Gabriel Aladegbami, M.D

  • Surgery Physician
  • Dallas, TX
National Provider Identifier
1831452952
Registry record updated Sep 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2012020063 Issued in MO
Practice address
3417 Gaston Ave Ste 965
Dallas, TX 75246-2036
Phone
(972) 817-6050
NPI assigned
Jun 22, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2012020063 MO Primary

Addresses

Primary practice location

3417 Gaston Ave Ste 965
Dallas, TX 75246-2036

Mailing address

3417 Gaston Ave Ste 965
Dallas, TX 75246-2036
Phone (972) 817-6050

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address baladegbami823867@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, TX2 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

Enrollment IDStateProvider typePAC IDDetails
I20150223000800 MO Practitioner - Emergency Medicine 9830414523 Reassigns benefits to 2 organizations
I20211018002849 TX Practitioner - General Surgery 9830414523 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

3417 Gaston Ave
Suite 965
Dallas, TX 75246-2036
Phone (214) 820-7010

Hospital & facility affiliations

  • Baylor University Medical Center Hospital, Dallas, TX, CCN 450021

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2012020063MOMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poplar Bluff Hma Physician Management, LLC Surgery CurrentSince Dec 1, 2022 Accepting new patients
Hermann Area Hospital District CurrentSince Dec 31, 2014 Accepting new patients
Hermann Area Hospital District CurrentSince Dec 31, 2014 Accepting new patients
Healthtexas Provider Network Surgery CurrentSince Sep 27, 2021 Accepting new patients
Healthtexas Provider Network CurrentSince Sep 27, 2021 Accepting new patients
Healthtexas Provider Network Past Accepting new patients

Locations

509 W 18th St
Hermann, MO 65041
Phone (573) 486-2045

3098 Oak Grove Rd
Poplar Bluff, MO 63901
Phone (573) 778-2600

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

3417 Gaston Ave
Ste 965
Dallas, TX 75246
Phone (214) 820-7010

301 N Washington Ave
Fl 5
Dallas, TX 75246
Phone (469) 800-8742

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

Interoperability endpoints

  • Direct secure messaging: baladegbami823867@direct.sw.org
  • FHIR API: https://fhir-myrecord.cerner.com/r4/f62890b5-77ff-44bd-a981-0a0981047b35/

Organizations & group practices 6

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 1

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": "1340323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1831452952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3417 GASTON AVE STE 965",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752462036",
            "telephone_number": "972-817-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3417 GASTON AVE STE 965",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752462036",
            "telephone_number": "972-817-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALADEGBAMI",
        "first_name": "BOLA",
        "middle_name": "GABRIEL",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-22",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2012020063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "baladegbami823867@direct.sw.org",
            "affiliation": "N",
            "address_1": "3417 Gaston Ave Ste 965",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752462036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.