Oluwatosin Aanuoluwa Alo, MD
Individual provider Active NPI Family Medicine Physician · Fresh Meadows, NY
NPI 1922762178 · NPPES record last updated Apr 28, 2022
Key facts
- NPI
- 1922762178
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 125.079502 (IL)
- Practice address
- 7149 160TH St
Fresh Meadows, NY 11365-3077 - Phone
- (312) 538-8100
- NPI assigned
- Oct 25, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Carle Health Care Incorporated
Practice addresses (Care Compare)
1701 W Curtis Rd
Champaign, IL 61822-9678
Phone (217) 365-6200
1818 E Windsor Rd
Urbana, IL 61802-9566
Phone (217) 255-9500
611 W Park St
Urbana, IL 61801-2500
611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753
Hospital & facility affiliations
- Carle Foundation Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241211000789 | IL | Practitioner - Family Practice | 7517357601 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.079502 | IL | MD | Family Medicine Physician |
| P112714 | NY | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hoopeston Community Memorial Hospital | Current |
Accepting new patients | |
| Carle Health Care Incorporated | Family Medicine | Current |
Accepting new patients |
| Hoopeston Community Memorial Hospital | Family Medicine | Current | Accepting new patients |
| Hoopeston Community Memorial Hospital | Current | Accepting new patients |
Locations
701 E Orange St
Hoopeston, IL 60942
Phone (217) 283-5531
611 W Park St
Urbana, IL 61801
Phone (217) 383-6941
Interoperability endpoints
- oalomd349792@carlehiedirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | P112714 | NY | |
| Family Medicine Physician | 207Q00000X | 125.079502 | IL | Yes |
Addresses
Primary practice location
7149 160TH St
Fresh Meadows, NY 11365-3077
Mailing address
7149 160TH St
Fresh Meadows, NY 11365-3077
Other providers in Fresh Meadows, NY
- Eldina Alibabic
- Rachel Alishayev
- David Allayev
- Sara M Allayev
- Leslye Chantal Allen
- Corinne Alois
- Stephanie L Alvarado
- Mayerling Alvarez Lopez
- Nicole Angelica Alvarez
- Ayaz Alwani
All providers in Fresh Meadows, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.