NPIMap

Individual provider Active NPI

Adebukola Taiwo, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Fayetteville, NC
National Provider Identifier
1902884364
Registry record updated May 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
0090-00454 Issued in NC
Practice address
101 Robeson St
Suite 202
Fayetteville, NC 28301-5552
Phone
(910) 609-1630
Fax
(910) 609-1636
NPI assigned
Jan 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 0090-00454 NC Primary

Addresses

Primary practice location

101 Robeson St
Suite 202
Fayetteville, NC 28301-5552

Mailing address

PO Box 40908
Fayetteville, NC 28309-0908
Phone (910) 609-6448

Other identifiers 1

IdentifierTypeStateIssuer
5902372MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20051117000776 NC Practitioner - Internal MedicinePractitioner - Geriatric Medicine 3476584012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

101 Robeson St
Fayetteville, NC 28301-5520

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0090-00454NCMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cumberland County Hospital System Inc CurrentSince Oct 3, 2005 Accepting new patients
Cumberland County Hospital System Inc Current Accepting new patients
Cumberland County Hospital Systems, Inc CurrentSince Oct 3, 2005 Accepting new patients
Cumberland County Hospital System Inc Past Accepting new patients

Locations

101 Robeson St
Ste 202
Fayetteville, NC 28301
Phone (910) 609-1630

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

Interoperability endpoints

  • Direct secure messaging: ataiwo10274@capefearvalley.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Autumn Care of FayettevilleFayetteville, NC, CCN 345553 Skilled nursing facility Adp of the SNF Apr 1, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369008000000",
    "number": "1902884364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283090908",
            "telephone_number": "910-609-6448",
            "fax_number": "910-609-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 ROBESON ST",
            "address_2": "SUITE 202",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015552",
            "telephone_number": "910-609-1630",
            "fax_number": "910-609-1636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAIWO",
        "first_name": "ADEBUKOLA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2013-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "0090-00454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902372",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.