NPIMap

Individual provider Active NPI

Adeyinka Adebayo Agbetoyin, MD

  • Cardiovascular Disease Physician
  • Jackson, TN
National Provider Identifier
1922047422
Registry record updated Apr 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
36918 Issued in TN
Practice address
2968 North Highland Ave
Jackson, TN 38305
Phone
(731) 256-1819
Fax
(731) 664-4330
NPI assigned
Jun 6, 2006
Last updated
Apr 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 36918 TN Primary

Addresses

Primary practice location

2968 North Highland Ave
Jackson, TN 38305

Mailing address

2968 North Highland Avenue
Suite a
Jackson, TN 38305-3609
Phone (731) 256-1819

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20060321000190 TN Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Peripheral Vascular Disease 9032126743 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Peripheral Vascular Disease
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cardiovascular Clinic of West TN PCGroup PAC ID 5092800920, 3 clinicians

Practice addresses (Care Compare)

2968 N Highland Ave
Jackson, TN 38305-3409
Phone (731) 256-1819

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair1-10
Varicose vein removal17
Leg revascularization (restoring blood flow)24

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36918TNMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Cardiovascular Clinic of West Tennessee,P.C. Cardiovascular Disease Current Accepting new patients
Cardiovascular Clinic of West TN PC Cardiovascular Disease CurrentSince Aug 1, 2007 Accepting new patients
Mid - South Heart Center PC Past Accepting new patients

Locations

162 Murray Guard Dr
Ste A
Jackson, TN 38305
Phone (731) 207-6282

2968 N Highland Ave
Jackson, TN 38305
Phone (731) 256-1819

2968 N Highland Ave
Ste A
Jackson, TN 38305

117 Kennedy Dr
Martin, TN 38237
Phone (731) 587-9511

Interoperability endpoints

  • Direct secure messaging: aagbetoy@yourcarecommunity.org
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • FHIR API: https://fhir4.healow.com/fhir/r4/DAGDAA

Organizations & group practices 3

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 5

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714262400000",
    "number": "1922047422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2968 NORTH HIGHLAND AVENUE",
            "address_2": "SUITE A",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053609",
            "telephone_number": "731-256-1819",
            "fax_number": "731-664-4330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2968 NORTH HIGHLAND AVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "38305",
            "telephone_number": "731-256-1819",
            "fax_number": "731-664-4330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGBETOYIN",
        "first_name": "ADEYINKA",
        "middle_name": "ADEBAYO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2024-04-28",
        "certification_date": "2024-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "36918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.