Physician Compare National (NPI:1972955375)

HEALTHCARE PROVIDER: ADEWALE O ODOFIN 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	1972955375
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3375876899
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190614000699
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ODOFIN
	Individual professional last name
Provider First Name	ADEWALE
	Individual professional first name
Provider Middle Name	O
	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	2012
	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	HOSPITALIST
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HOSPITALIST
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	CENTRACARE HEALTH SYSTEM - NR LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	3870739410
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	31
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1013 HART BLVD
	Group Practice or individual's line 1 address
City	MONTICELLO
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	553628575
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7632952945
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	240036
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST CLOUD HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	240001
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NORTH MEMORIAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	240030
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	DOUGLAS COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	240075
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	ESSENTIA HEALTH ST JOSEPH'S MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y