Olubayo A Idowu, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

K06009 Issued in TX

Practice address

2727 Bolton Boone Dr
#102
Desoto, TX 75115-2019

Phone

(972) 283-8777

Fax

(972) 283-9333

NPI assigned

Apr 9, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: olubayo.idowu@oaimp.eclinicaldirectplus.com

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.

• Propercare Internal Medicine PA

  • Internal Medicine Physician
  • Desoto, TX
  • NPI 1922337088
  Medicare reassignment NPD

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311033600000",
    "number": "1891818399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2727 BOLTON BOONE DR",
            "address_2": "#102",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152019",
            "telephone_number": "972-283-8777",
            "fax_number": "972-283-9333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 BOLTON BOONE DR",
            "address_2": "#102",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152019",
            "telephone_number": "972-283-8777",
            "fax_number": "972-283-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDOWU",
        "first_name": "OLUBAYO",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-09",
        "last_updated": "2011-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "K06009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111880404",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENCE",
            "identifier": "K06009",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Desoto, TX
• Providers in Desoto, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.