Samuel Adekunle Adefeyisan, MD is a medicare enrolled "Anesthesiology" physician in Grand Prairie, Texas. He graduated from medical school in 1986 and has 40 years of diverse experience with area of expertise as Anesthesiology. He is a member of the group practice Hospitalist Medicine Physicians Of Georgia - Tcs, Pc, Self Medical Group and his current practice location is
4314 Clayton St, Grand Prairie, Texas. You can reach out to his office (for appointments etc.) via phone at
(214) 708-9590.
Samuel Adekunle Adefeyisan is licensed to practice in Georgia (license number 062934) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1568673556.
Physician's Profile
| Full Name | Samuel Adekunle Adefeyisan |
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| Gender | Male |
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| Speciality | Anesthesiology |
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| Experience | 40 Years |
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| Location | 4314 Clayton St, Grand Prairie, Texas |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Samuel Adekunle Adefeyisan graduated from medical school in 1986
NPI Data:
- NPI Number: 1568673556
- Provider Enumeration Date: 05/24/2007
- Last Update Date: 12/16/2024
Medicare PECOS Information:
- PECOS PAC ID: 8527183839
- Enrollment ID: I20190820003073
Medical Identifiers
Medical identifiers for Samuel Adekunle Adefeyisan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1568673556 | NPI | - | NPPES |
| Q46839 | Medicaid | SC | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207L00000X | Anesthesiology | MD.29707 (Alabama) | Secondary |
| 207L00000X | Anesthesiology | 83699 (South Carolina) | Secondary |
| 208000000X | Pediatrics | 062934 (Georgia) | Secondary |
| 208000000X | Pediatrics | MD.2009 (Alabama) | Secondary |
| 2080P0203X | Pediatrics - Pediatric Critical Care Medicine | 062934 (Georgia) | Secondary |
| 2080P0203X | Pediatrics - Pediatric Critical Care Medicine | MD.29707 (Alabama) | Secondary |
| 207L00000X | Anesthesiology | 062934 (Georgia) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Hospitalist Medicine Physicians Of Georgia - Tcs, Pc | 3971024910 | 75 |
| Self Medical Group | 6002953916 | 363 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Samuel Adekunle Adefeyisan allows following entities to bill medicare on his behalf.
| Entity Name | American Anesthesiology Associates Of Georgia Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1528068673
PECOS PAC ID: 7618934779
Enrollment ID: O20041210000442 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Samuel Adekunle Adefeyisan is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Samuel Adekunle Adefeyisan, MD
4314 Clayton St,
Grand Prairie, TX 75052-3433
Ph: (214) 708-9590 | Samuel Adekunle Adefeyisan, MD
4314 Clayton St,
Grand Prairie, TX 75052-3433
Ph: (214) 708-9590 |
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