Marc T. Awobuluyi, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

A84420 Issued in CA

Practice address

11995 Singletree LN Ste 500
Eden Prairie, MN 55344-5349

Phone

(952) 595-1100

Fax

(612) 294-4903

NPI assigned

Aug 30, 2006

Last updated

Jun 25, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, OH, PA, MO, IL, TN, NY, NJ, AZ, NV, WA11 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 11

Specialty

Diagnostic Radiology

Education

Harvard Medical School, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lambert Radiology Medical Group IncGroup PAC ID 8224032271, 68 clinicians

Heritage Valley Radiology, Inc.Group PAC ID 6305348947, 13 clinicians

Reono Bertagnolli a Medical GroupGroup PAC ID 6800709783, 47 clinicians

Kan-Di-Ki LLCGroup PAC ID 5991737140, 38 clinicians

Image Guided Therapeutics IncGroup PAC ID 6608874896, 16 clinicians

Community Mobile Diagnostics LLCGroup PAC ID 4789610643, 9 clinicians

American Diagnostics Services LLCGroup PAC ID 1355241274, 15 clinicians

Symphony Diagnostic Services No 1 LLCGroup PAC ID 5193638765, shared by 3 NPIs, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• UCSF Health St. Mary's Hospital Hospital, San Francisco, CA, CCN 050457
• Sequoia Hospital Hospital, Redwood City, CA, CCN 050197
• Pih Health Hospital-Whittier Hospital, Whittier, CA, CCN 050169
• Pih Health Good Samaritan Hospital Hospital, Los Angeles, CA, CCN 050471
• UCSF Health Saint Francis Hospital Hospital, San Francisco, CA, CCN 050152

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Heritage Valley Radiology, Inc.

  • Diagnostic Radiology Physician
  • Beaver, PA
  • NPI 1982403739
  Medicare reassignment Care Compare group NPD
• Lambert Radiology Medical Group, Inc

  • Diagnostic Radiology Physician
  • Whittier, CA
  • NPI 1609826684
  Medicare reassignment Care Compare group NPD
• American Diagnostics Services LLC

  dba TridentCare

  • Physiological Laboratory
  • Windsor Mill, MD
  • NPI 1639140387

  CA, TN

  Medicare reassignment Care Compare group
• Community Mobile Diagnostics LLC

  dba Tridentcare

  • Diagnostic Radiology Physician
  • San Leandro, CA
  • NPI 1023104007

  NY, OH

  Medicare reassignment Care Compare group
• Image Guided Therapeutics, Inc.

  • Diagnostic Radiology Physician
  • San Francisco, CA
  • NPI 1316968910
  Medicare reassignment Care Compare group
• Kan-Di-Ki, LLC

  dba Diagnostic Laboratories

  • Diagnostic Ultrasound Physician
  • North Hollywood, CA
  • NPI 1548422488

  OH, PA

  Medicare reassignment Care Compare group
• Reono Bertagnolli a Medical Group

  dba Rely Radiology Group of California

  • Diagnostic Radiology Physician
  • San Leandro, CA
  • NPI 1134424005

  IL, MO, NJ, NY, PA, WA

  Medicare reassignment Care Compare group
• Brighton Radiology Associates, P.C.

  • Diagnostic Radiology Physician
  • Beaver, PA
  • NPI 1881672434

  CA, OH

  Medicare reassignment NPD
• Ellis Bandt Birkin Kollins & Wong PLLC

  dba Desert Radiology

  • Diagnostic Radiology Physician
  • Las Vegas, NV
  • NPI 1578584678

  CA

  Medicare reassignment NPD
• Gainesville Radiology Group, PC

  • Diagnostic Radiology Physician
  • Gainesville, GA
  • NPI 1922037605

  CA

  Medicare reassignment NPD
• Kan-Di-Ki LLC

  dba Diagnostic Laboratories

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Tukwila, WA
  • NPI 1124340039
  Medicare reassignment NPD
• Kan-Di-Ki, LLC

  dba Diagnostic Laboratories

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Las Vegas, NV
  • NPI 1811210289
  Medicare reassignment NPD

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

• Dignity Community Care

  dba Sequoia Hospital

  • General Acute Care Hospital
  • Redwood City, CA
  • NPI 1568646735
  Care Compare affiliation
• Pih Health Good Samaritan Hospital

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1508859323
  Care Compare affiliation
• Pih Health Whittier Hospital

  • General Acute Care Hospital
  • Whittier, CA
  • NPI 1043215379
  Care Compare affiliation
• UCSF Health Community Hospitals

  dba UCSF Health - St. Mary's Hospital

  • General Acute Care Hospital
  • San Francisco, CA
  • NPI 1174667158
  Care Compare affiliation
• UCSF Health Community Hospitals

  dba UCSF Health Hyde Hospital

  • General Acute Care Hospital
  • San Francisco, CA
  • NPI 1316061997
  Care Compare affiliation

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1962512145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11995 SINGLETREE LN STE 500",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445349",
            "telephone_number": "952-595-1100",
            "fax_number": "612-294-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11995 SINGLETREE LN STE 500",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445349",
            "telephone_number": "952-595-1100",
            "fax_number": "612-294-4903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AWOBULUYI",
        "first_name": "MARC",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A84420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Aurora Health
• Avia Home Health Care LLC
• Awakening Wholeness LLC
• Emmaculate Bih Awasom
• Ruweyda Aydarus
• Rachel Ann Baber, OTR/L
• Daniel L Bachicha, PH.D.
• William Russell Bacon, MD
• Queety Badio

• Diagnostic Radiology Physician in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Diagnostic Radiology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; 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.