Abisoye A Adebayo, MD
Individual provider Active NPI Geriatric Medicine (Family Medicine) Physician · Appleton, WI
NPI 1942720727 · NPPES record last updated Nov 9, 2021
Key facts
- NPI
- 1942720727
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Geriatric Medicine (Family Medicine) Physician 207QG0300X
- License
- 76012 (WI)
- Practice address
- 2600 S Heritage Woods Dr
Appleton, WI 54915-1408 - Phone
- (920) 225-7875
- NPI assigned
- Jun 22, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 15
Hospital & facility affiliations 21
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Thedacare, Incorporated
Practice addresses (Care Compare)
2600 S Heritage Woods Dr
Appleton, WI 54915-1408
Phone (920) 225-7720
Hospital & facility affiliations
- Bristol Hospice Green Bay
- Thedacare at Home
- Compassus Green Bay
- St Croix Hospice de Pere
- Unity Hospice
- Thedacare Regional Medical Center - Appleton Inc
- Thedacare Regional Med Ctr - Neenah
- Thedacare Medical Center - Shawano
- Rennes Health and Rehab Center-Appleton
- Oakridge Gardens Nur Ctr, Inc
- Edenbrook of Appleton North
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA, WI
- 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 |
|---|---|---|---|---|
| I20200811001047 | IA | Practitioner - Family Practice | 2860762192 | Reassigns benefits to 1 organization |
| I20211020000898 | WI | Practitioner - Family Practice |
2860762192 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-10900 | IA | MD | Family Medicine Physician |
| 76012 | WI | MD | Geriatric Medicine (Family Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health Services of Central Georgia, Inc | Family Medicine | Current |
Accepting new patients |
| Avera Holy Family | Current | Accepting new patients | |
| Thedacare, Incorporated | Family Medicine | Current |
Accepting new patients |
| The Medical Center of Central Georgia Inc | Past |
Accepting new patients |
Locations
4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800
3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229
1405 Mill St
New London, WI 54961
Phone (920) 531-2000
600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000
Interoperability endpoints
- aadebayo315848@direct.thedacare.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R-10900 | IA | |
| Family Medicine Physician | 207Q00000X | 76012 | WI | |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 12183 | GA | |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 76012 | WI | Yes |
Addresses
Primary practice location
2600 S Heritage Woods Dr
Appleton, WI 54915-1408
Mailing address
2600 S Heritage Woods Dr
Appleton, WI 54915-1408
Phone (920) 225-7875
Other practice location 1
3780 Eisenhower Pkwy
Macon, GA 31206-0800
Phone (478) 633-5556
Other providers in Appleton, WI
- Shalini Achanti
- Peter Hummel Ackell
- Ernesto L Acosta
- Acupuncture & Herb Center, Inc
- Acupuncture & Herb Center, Inc.
- Melissa L Adelman
- Anna Adesso
- Karen R Adler-Fischer
- Melissa L Adlington
- Mark G Adorjan
All providers in Appleton, WI · Geriatric Medicine (Family Medicine) Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2021. 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.