Individual provider Active NPI

Adedotun A. Ogunsua, M.D.

  • Interventional Cardiology Physician
  • Evergreen Park, IL
National Provider Identifier
1922448661
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
80966 Issued in MT
Practice address
3545 W 95TH St
Evergreen Park, IL 60805-2135
Phone
(708) 346-5562
Fax
(406) 731-8876
NPI assigned
Jun 26, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 80966 MT Primary

Addresses

Primary practice location

3545 W 95TH St
Evergreen Park, IL 60805-2135

Mailing address

3545 W 95TH St
Evergreen Park, IL 60805-2135
Phone (708) 346-5562

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ogunsua@direct.practicefusion.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT, IL2 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
I20200902001684 MT Practitioner - Interventional Cardiology 8022240019 Reassigns benefits to 1 organization
I20231106001362 IL Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 8022240019 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
University of Massachusetts Medical School, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Consultants in Cardiology and Electrophysiololgy LLCGroup PAC ID 4880779727, 21 clinicians

Practice addresses (Care Compare)

3545 W 95TH St
Evergreen Park, IL 60805-2135
Phone (708) 346-5562

Hospital & facility affiliations

  • Osf Little Company of Mary Medical Center Hospital, Evergreen Park, IL, CCN 140179
  • Advocate Christ Hospital & Medical Center Hospital, Oak Lawn, IL, CCN 140208
  • Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting23
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
80966MTMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Consultants in Cardiology & Electrophysiololgy LLC Interventional Cardiology CurrentSince Oct 1, 2023 Accepting new patients
Benefis Hospitals Inc CurrentSince Aug 26, 2020 Accepting new patients

Locations

3545 W 95th St
Evergreen Pk, IL 60805
Phone (708) 435-9036

1101 26th St S
Fl 5
Great Falls, MT 59405
Phone (406) 455-2132

1401 25th St S
Great Falls, MT 59405
Phone (406) 455-3650

1101 26th St S
Great Falls, MT 59405
Phone (406) 455-4690

Interoperability endpoints

  • Direct secure messaging: aogunsua385787@direct.myadvocateaurora.org

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 and National Provider Directory roles.

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": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714608000000",
    "number": "1922448661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545 W 95TH ST",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052135",
            "telephone_number": "708-346-5562",
            "fax_number": "708-346-2059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3545 W 95TH ST",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052135",
            "telephone_number": "708-346-5562",
            "fax_number": "406-731-8876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGUNSUA",
        "first_name": "ADEDOTUN",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-26",
        "last_updated": "2024-05-02",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MT",
            "license": "80966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ogunsua@direct.practicefusion.com",
            "affiliation": "N",
            "address_1": "3545 W 95th St",
            "city": "Evergreen Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "608052135",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Evergreen Park, IL

Sources for this page

Verify at the official NPI Registry.