NPIMap

Individual provider Active NPI

Kofoworola Ekadi, M.D.

  • Internal Medicine Physician
  • Burleson, TX
National Provider Identifier
1942262316
Registry record updated Dec 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
K9263 Issued in TX
Practice address
12001 South Fwy
Ste 210
Burleson, TX 76028-7208
Phone
(817) 293-8797
Fax
(817) 293-8793
NPI assigned
Apr 3, 2006
Last updated
Dec 30, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X NU
Internal Medicine Physician 207R00000X K9263 TX Primary

Addresses

Primary practice location

12001 South Fwy
Ste 210
Burleson, TX 76028-7208

Mailing address

PO Box 93869
Southlake, TX 76092-0118
Phone (817) 293-8797

Other identifiers 2

IdentifierTypeStateIssuer
060392367MedicaidTX
P00053593OtherRAILROAD MEDICARE

Other names 1

  • Dr. Kofowrola Falola Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20031216000359 TX Practitioner - Internal Medicine 2466358106 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

12001 S Fwy
Suite 210
Burleson, TX 76028-7214
Phone (817) 293-8797

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Delta Medical PA Internal Medicine CurrentSince Jun 30, 2006 Accepting new patients
Global Therapy Services LLC CurrentSince Apr 16, 2023 Accepting new patients
Texas Health Physicians Group Past Accepting new patients
Tarrant Family Practice P.a Past Accepting new patients

Locations

12001 South Fwy
Ste 210
Burleson, TX 76028
Phone (817) 293-8797

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HEDJCD
  • Direct secure messaging: kofo.ekadi@dmpa.eclinicaldirectplus.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672358400000",
    "number": "1942262316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 93869",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760920118",
            "telephone_number": "817-293-8797",
            "fax_number": "817-293-8793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12001 SOUTH FWY",
            "address_2": "STE 210",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760287208",
            "telephone_number": "817-293-8797",
            "fax_number": "817-293-8793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EKADI",
        "first_name": "KOFOWOROLA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-03",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "K9263",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060392367",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00053593",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KOFOWROLA",
            "last_name": "FALOLA",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Burleson, TX

Sources for this page

Verify at the official NPI Registry.