Samuel Adekunle Adefeyisan, MD is a medicare enrolled "Anesthesiology" physician in Grand Prairie, Texas. He graduated from medical school in 1986 and has 38 years of diverse experience with area of expertise as Anesthesiology. He is a member of the group practice Musc Community Physicians, Medstream Anesthesia Pllc, Medstream Anesthesia Pllc 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 | 38 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: 03/21/2024
Medicare PECOS Information:
- PECOS PAC ID: 8527183839
- Enrollment ID: I20200325000377
Medical Identifiers
Medical identifiers for Samuel Adekunle Adefeyisan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1568673556 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207L00000X | Anesthesiology | 83699 (South Carolina) | Secondary |
| 207L00000X | Anesthesiology | MD.29707 (Alabama) | 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 |
|---|
| Musc Community Physicians | 6507260668 | 698 |
| Medstream Anesthesia Pllc | 7416198049 | 566 |
| Medstream Anesthesia Pllc | 7416198049 | 566 |
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 | Medstream Anesthesia Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1649616160
PECOS PAC ID: 7416198049
Enrollment ID: O20140304001021 |
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| Entity Name | Musc Community Physicians |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1841878006
PECOS PAC ID: 6507260668
Enrollment ID: O20210811002388 |
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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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