Babatunde Olutade (NPI# 1316050750, PAC ID# 0244311025) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NEPHROLOGY.
| Nation Provider ID (NPI) | 1316050750 |
| PAC ID by PECOS | 0244311025 |
| Professional Enrollment ID | I20120718000321 |
| Full Name | Babatunde Olutade |
| Organization Legal Name | DIVERSIFIED RENAL GROUP LLC |
| Address |
6501 Dogwood View Pkwy Suite A Jackson MS 39213-7857 |
| Phone Number | 6018993340 |
| Gender | M |
| Graduation Year | 1981 |
| Primary Specialty | NEPHROLOGY |
| Group Practice PAC ID | 6406815299 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 250048 | ST DOMINIC-JACKSON MEMORIAL HOSPITAL |
| 250072 | MERIT HEALTH CENTRAL |
| 250102 | MISSISSIPPI BAPTIST MEDICAL CENTER |
| 250038 | MERIT HEALTH MADISON |
| Address | Phone | Organization |
|---|---|---|
| 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 | 6018993340 | DIVERSIFIED RENAL GROUP LLC |
| Organization Legal Name | DIVERSIFIED RENAL GROUP LLC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Hollye R Johnson | Nephrology | Diversified Renal Group LLC | 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 |
| Gary M Davis | Nephrology | Diversified Renal Group LLC | 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 |
| Street Address |
6501 DOGWOOD VIEW PKWY SUITE A |
| City | JACKSON |
| State | MS |
| Zip | 39213-7857 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael A Reddix | Internal Medicine | Reddix Family Clinic Pa | 6501 Dogwood View Pkwy, Suite B, Jackson, MS 39213-7857 |
| Hollye R Johnson | Nephrology | Diversified Renal Group LLC | 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 |
| Natalie Y Brookins-reddix | Internal Medicine | Reddix Family Clinic Pa | 6501 Dogwood View Pkwy, Suite B, Jackson, MS 39213-7857 |
| Kim Cooper | Nurse Practitioner | Reddix Family Clinic Pa | 6501 Dogwood View Pkwy, Suite B, Jackson, MS 39213-7857 |
| James B Moore | Nephrology | 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 | |
| Maurice Mcshan | Internal Medicine | Reddix Family Clinic Pa | 6501 Dogwood View Pkwy, Suite B, Jackson, MS 39213-7857 |
| Gary M Davis | Nephrology | Diversified Renal Group LLC | 6501 Dogwood View Pkwy, Suite A, Jackson, MS 39213-7857 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amanda B. Greene | Nurse Practitioner | State of Mississippi-university of Mississippi Medical Center | 350 W Woodrow Wilson Dr, Cancer Institute, Jackson, MS 39213 |
| Jaleen D Sims | Obstetrics/gynecology | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Iesha Renee Williams | Nurse Practitioner | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Nobel D Attipoe | Obstetrics/gynecology | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Keila L Brown | Nurse Practitioner | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Tritresher Sizer | Nurse Practitioner | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Willye A Bell | Certified Nurse Midwife (cnm) | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Jan M Hausmann | Internal Medicine | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Sonia L Walker | Nurse Practitioner | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Barbara L Tapps | Nurse Practitioner | Central Mississippi Civic Improvement Association, Inc | 3502 W Northside Dr, Jackson, MS 39213-4454 |
| Find all physicians in zip 39213 | |||
| City | JACKSON |
| Zip Code | 39213 |
| Specialty | NEPHROLOGY |
| City + Specialty | JACKSON + NEPHROLOGY |
Please comment or provide details below to improve the information on Babatunde Olutade.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.