Ayodale Samuella Odulate, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

A104364 Issued in CA

Practice address

7601 Pioneers Blvd
Lincoln, NE 68506-4675

Phone

(402) 484-6677

NPI assigned

Mar 6, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Ayodale Samuella Johnson Former name

Medicare fee-for-service enrollment

Enrolled in NE

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 1

Specialty

Diagnostic Radiology

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Madonna Rehabilitation HospitalGroup PAC ID 0446164081, 92 clinicians

Advanced Medical Imaging LLCGroup PAC ID 0840265773, 38 clinicians

Radiology Associates PCGroup PAC ID 5698735181, 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Phelps Memorial Health Center Hospital, Holdrege, NE, CCN 281362
• Fillmore County Hospital Hospital, Geneva, NE, CCN 281301
• York General Health Care Services Hospital, York, NE, CCN 281336
• Lexington Regional Health Center Hospital, Lexington, NE, CCN 281361
• Cozad Community Hospital Hospital, Cozad, NE, CCN 281327

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Advanced Medical Imaging, LLC

  • Diagnostic Radiology Physician
  • Lincoln, NE
  • NPI 1437116936
  Medicare reassignment Care Compare group NPD
• Madonna Rehabilitation Hospital

  • Physical Medicine & Rehabilitation Physician
  • Lincoln, NE
  • NPI 1417045642
  Medicare reassignment Care Compare group NPD
• Radiology Associates PC

  • Diagnostic Radiology Physician
  • Lincoln, NE
  • NPI 1548227036
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cozad Community Hospital

  • Critical Access Hospital
  • Cozad, NE
  • NPI 1881632883
  Care Compare affiliation
• Fillmore County Hospital

  • Critical Access Hospital
  • Geneva, NE
  • NPI 1689769382
  Care Compare affiliation
• Lexington Regional Health Center

  • Critical Access Hospital
  • Lexington, NE
  • NPI 1467417352
  Care Compare affiliation
• Phelps Memorial Health Center

  • Critical Access Hospital
  • Holdrege, NE
  • NPI 1629035936
  Care Compare affiliation
• York General Hospital

  • Critical Access Hospital
  • York, NE
  • NPI 1588764898
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643328000000",
    "number": "1952378283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 ARLINGTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 PIONEERS BLVD",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685064675",
            "telephone_number": "402-484-6677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Kennedy Dr",
            "address_2": "Suite 702",
            "address_purpose": "LOCATION",
            "city": "Malden",
            "state": "MA",
            "postal_code": "021483326",
            "country_code": "US",
            "telephone_number": "781-519-0226",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Kennedy Dr",
            "address_2": "Suite 702",
            "address_purpose": "LOCATION",
            "city": "Malden",
            "state": "MA",
            "postal_code": "021483326",
            "country_code": "US",
            "telephone_number": "781-519-0226",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3660 Arlington Ave",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "92506",
            "country_code": "US",
            "telephone_number": "951-782-3045",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7117 Brockton Ave",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925062658",
            "country_code": "US",
            "telephone_number": "951-782-3720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODULATE",
        "first_name": "AYODALE",
        "middle_name": "SAMUELLA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-06",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MA",
            "license": "225130",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A104364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AYODALE",
            "last_name": "JOHNSON",
            "middle_name": "SAMUELLA",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bianca Midori Ocuno
• John R Odell, LIMHP LMHP LPC
• Jackie Kay Oden, RN APRN
• Lindey Odenore
• Elizabeth Margaret Odgers, MA
• Tamara Lynne Oehler, MSN, BSN, RN, FNP-BC
• Annette M Oehm
• Krysta Oehm, M.A., LIMHP, CPC
• Ariel Oehring
• Savannah Oeltjen

• Diagnostic Radiology Physician in Lincoln, NE
• Providers in Lincoln, NE by specialty
• Diagnostic Radiology Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.