NPIMap

Individual provider Active NPI

Gafar Ajani Adesoji, M.D

  • Internal Medicine Physician
  • Southaven, MS
National Provider Identifier
1861414708
Registry record updated Mar 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
16532 Issued in MS
Practice address
8412 Airways Blvd
Building C,Suite 5B
Southaven, MS 38671-5140
Phone
(662) 536-2100
Fax
(662) 536-2211
NPI assigned
Jul 23, 2006
Last updated
Mar 17, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD0000035864 TN
Internal Medicine Physician 207R00000X 16532 MS Primary

Addresses

Primary practice location

8412 Airways Blvd
Building C,Suite 5B
Southaven, MS 38671-5140

Mailing address

PO Box 1078
Southaven, MS 38671-0011
Phone (662) 536-2100

Other practice location 1

7601 Southcrest Pkwy
Southaven, MS 38671-4739
Phone (662) 772-4000

Other identifiers 1

IdentifierTypeStateIssuer
01724394MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20050513000493 MS Practitioner - Internal Medicine 3971544511 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

8412 Airways Blvd
Southaven, MS 38671-5140
Phone (662) 536-2100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16532MSMDInternal Medicine Physician
MD0000035864TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Progressive Physicians Practice Internal Medicine CurrentSince Dec 1, 2002 Accepting new patients
Clarksdale Hma LLC Past Accepting new patients

Locations

8412 Airways Blvd
Southaven, MS 38671
Phone (662) 536-2100

8412 Airways Blvd
Ste 5B
Southaven, MS 38671
Phone (662) 536-2100

Interoperability endpoints

  • Direct secure messaging: gadesoji26230@mlh.direct-ci.com

Organizations & group practices 2

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 8

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": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1861414708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1078",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386710011",
            "telephone_number": "662-536-2100",
            "fax_number": "662-536-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8412 AIRWAYS BLVD",
            "address_2": "BUILDING C,SUITE 5B",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715140",
            "telephone_number": "662-536-2100",
            "fax_number": "662-536-2211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7601 Southcrest Pkwy",
            "address_purpose": "LOCATION",
            "city": "Southaven",
            "state": "MS",
            "postal_code": "386714739",
            "country_code": "US",
            "telephone_number": "662-772-4000",
            "fax_number": "662-772-2960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADESOJI",
        "first_name": "GAFAR",
        "middle_name": "AJANI",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-23",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD0000035864",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "16532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01724394",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

Verify at the official NPI Registry.