Physician Compare National (NPI:1407944911)

HEALTHCARE PROVIDER: ADETAYO RICHARD ADEMUYIWA M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1407944911
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022033802
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111115000028
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ADEMUYIWA
	Individual professional last name
Provider First Name	ADETAYO
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	INDIANA UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	PULMONARY DISEASE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CRITICAL CARE (INTENSIVISTS)
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CRITICAL CARE (INTENSIVISTS)
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1101 W LIBERTY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 430
	Group Practice or individual's line 2 address
City	FARMINGTON
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	636401921
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	260163
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PARKLAND HEALTH CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	260023
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MERCY HOSPITAL JEFFERSON
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	261315
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	PARKLAND HEALTH CENTER-BONNE TERRE
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y