DR. AGBOLADE O. ODUTAYO (D.O.) – Emergency Medicine Physician, NPI 1316992779

DR. AGBOLADE O. ODUTAYO (D.O.) is a healthcare provider. based in Cameron, Texas. specializing in EMERGENCY MEDICINE, INTERNAL MEDICINE. They hold the professional credentials D.O.. They hold a License No. K6196 (TX). The NPI Number for DR. AGBOLADE O. ODUTAYO (D.O.) is 1316992779

Main info

Male
Sole Proprietor
30 Years Of Experience
Accepts Medicare Assignment
Name
DR. AGBOLADE O. ODUTAYO (D.O.)
NPI
1316992779
Phone
(254) 697-3100
Address
300 W 4TH ST
Enumeration Date
24 May 2006
Last Update Date
29 January 2024

Doctor Profile

Medical School Name
NEW YORK COLLEGE OF OSTEO MEDICINE OF NEW YORK INSTITUTE OF TECHNOLOGY
Secondary Phone
9369313891
Graduation Year
1996 (30 years ago)
PAC ID
6709873680
Group Practice PAC ID
3678942778
Professional Enrollment ID
I20040430000923
Address ID
TX758351810CR1100XLOOP302
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience74
Completeness75
Years active:20State licenses:1Digital endpointsOther names

4,051 EMERGENCY MEDICINE in TX

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Provider Addresses for DR. AGBOLADE O. ODUTAYO (D.O.)

  • 300, West 4th Street, Cameron, Milam County, Texas, 76520, United States

    CAMERON, TX 765202509

    Phone: (254) 697-3100

    Fax: (254) 697-3112

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-04-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040430000923IEmergency MedicineTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99285Emergency department visit with high level of medical decision making187166$0
99284Emergency department visit with moderate level of medical decision making168152$0
93010Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only120102$0
99283Emergency department visit with low level of medical decision making2221$0
12002Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.6-7.5 cm1111$0
View full utilization report →

Insurance plans in this area (ZIP 76520)

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Provider's Procedures

DR. AGBOLADE O. ODUTAYO (D.O.) performs procedures in EMERGENCY MEDICINE. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
EMERGENCY MEDICINETX93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report1313

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3678942778View full group profile
NameSpecialtyState
Family Practice, Emergency Medicine, Emergency MedicineNM
Family Practice, Emergency Medicine, HospitalistTX
Family Practice, Emergency MedicineTX
Family Practice, Emergency MedicineMS
Emergency Medicine, General SurgeryTX
Family Practice, Emergency MedicineTX
Emergency Medicine, Family PracticeTX
Family Practice, PsychiatryTX

Reviews

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Frequently asked questions

How is DR. AGBOLADE O. ODUTAYO (D.O.) identified in CMS data?
CMS-hosted NPPES data lists DR. AGBOLADE O. ODUTAYO (D.O.) with NPI 1316992779.
Is DR. AGBOLADE O. ODUTAYO (D.O.) listed as active for patients and plans?
The listing shows DR. AGBOLADE O. ODUTAYO (D.O.) as active in the NPI system.
What is DR. AGBOLADE O. ODUTAYO (D.O.)'s primary classification?
Emergency Medicine Physician is the headline specialty for DR. AGBOLADE O. ODUTAYO (D.O.) here. Clinical services aligned with this taxonomy classification.
What address line appears for DR. AGBOLADE O. ODUTAYO (D.O.)?
DR. AGBOLADE O. ODUTAYO (D.O.)'s geographic hint is Cameron, Texas in our summary view.
Why does DR. AGBOLADE O. ODUTAYO (D.O.) have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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