| Rotimi A Iluyomade, MD | |
| 
					6922 Little River Tpke Ste D, Annandale, VA 22003-3285  | |
| (703) 705-9306 | |
| (703) 890-3114 | 
| Full Name | Rotimi A Iluyomade | 
|---|---|
| Gender | Male | 
| Speciality | Emergency Medicine | 
| Location | 6922 Little River Tpke Ste D, Annandale, Virginia | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1043298615 | NPI | - | NPPES | 
| 000000521582 | Other | KY | BCBS | 
| 64013972 | Medicaid | KY | |
| 000000805251 | Other | KY | BCBS- BAPTIST HEALTH MADISONVILLE | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207P00000X | Emergency Medicine | 0101221294 (Virginia) | Secondary | 
| 207P00000X | Emergency Medicine | D0042228 (Maryland) | Primary | 
| Entity Name | Southern Medical Partners, Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1538109962 PECOS PAC ID: 8123923679 Enrollment ID: O20031206000036  | 
| Entity Name | Harrison Memorial Hospital | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1386783868 PECOS PAC ID: 8628961018 Enrollment ID: O20040209000207  | 
| Entity Name | Williamson Emergency Physicians Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1740492644 PECOS PAC ID: 5294828562 Enrollment ID: O20070831000176  | 
| Entity Name | Middlesborough Emergency Physicians Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1972715878 PECOS PAC ID: 9335232321 Enrollment ID: O20070907000084  | 
| Entity Name | Hyden Emergency Physicians, Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1497036776 PECOS PAC ID: 6103099163 Enrollment ID: O20111108000187  | 
| Entity Name | Concord Medical Group Of Kentucky Pllc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1346746385 PECOS PAC ID: 9133483894 Enrollment ID: O20180503002233  | 
| Entity Name | Concord Company Of Tennessee Pllc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1649743667 PECOS PAC ID: 0345588109 Enrollment ID: O20190221000097  | 
| Entity Name | Western Healthcare Services Kentucky Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1770243842 PECOS PAC ID: 0941695936 Enrollment ID: O20220309001033  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Rotimi A Iluyomade, MD 900 Hospital Dr, Madisonville, KY 42431-1644 Ph: (270) 825-5100  | Rotimi A Iluyomade, MD 6922 Little River Tpke Ste D, Annandale, VA 22003-3285 Ph: (703) 705-9306  |