Olubunmi Ashabi Alo, M.D.
Individual provider Active NPI Obstetrics & Gynecology Physician · Myrtle Beach, SC
NPI 1962637645 · NPPES record last updated Feb 16, 2021
Key facts
- NPI
- 1962637645
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 32378 (SC)
- Practice address
- 3864 Renee Drive
Myrtle Beach, SC 29579 - Phone
- (843) 353-2111
- Fax
- (843) 628-4326
- NPI assigned
- May 25, 2009
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 13
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3864 Renee Dr
Myrtle Beach, SC 29579-4108
Phone (843) 353-2111
Hospital & facility affiliations
- Conway Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- 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 |
|---|---|---|---|---|
| I20101103000186 | SC | Practitioner - Obstetrics/Gynecology | 5597959601 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32378 | SC | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Palmetto OBGYN LLC | Obstetrics & Gynecology | Current |
Accepting new patients |
| Conway Hospital, Inc. | Past | Accepting new patients |
Locations
3864 Renee Dr
Myrtle Beach, SC 29579
Phone (843) 353-2111
Interoperability endpoints
- https://api.platform.athenahealth.com/20947/brand/1/csg/1/fhir/r4
- olubunmi.alo.1@20947.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 32378 | SC | Yes |
Addresses
Primary practice location
3864 Renee Drive
Myrtle Beach, SC 29579
Mailing address
PO Box 51827
Myrtle Beach, SC 29579-0031
Phone (843) 353-2111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP9634 | Medicaid | SC |
Other providers in Myrtle Beach, SC
- Allexa Home Healthcare & Concierge Services
- Brad Douglas Allison
- Allouch Optometric, PC
- Fouad S Allouch
- Abdulelah Almutairi
- Amy Katherine Alsbrooks
- M'Kayla Alston
- Roberta Rae Alsworth
- Alternative Health Clinic
- Alternative Living Solutions of South Carolina LLC
All providers in Myrtle Beach, SC · Obstetrics & Gynecology Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 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.