Physician Compare National (NPI:1881776219)

HEALTHCARE PROVIDER: ADEGBENGA A ADETOLA MD

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

Individual Professional Information
NPI	1881776219
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6901993716
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071025000533
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ADETOLA
	Individual professional last name
Provider First Name	ADEGBENGA
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1988
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	NEPHROLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	NEPHROLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	3737 MARTIN LUTHER KING JR BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 400
	Group Practice or individual's line 2 address
City	LYNWOOD
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	902623542
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050104
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SAINT FRANCIS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y