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ABIDEMI GBOTOSHO DDS
NPI 1205145976
Dentist in Chicago, IL

Active since September 29, 2010PECOS Enrolled
1650 S ALBANY AVE, CHICAGO, IL 60623(347) 416-3147 Get Directions Write a Review

NPPES record last updated: April 23, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Apr 23, 2021, Jun 24, 2016 (2 updates tracked since 2016).

About Abidemi Gbotosho Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ABIDEMI GBOTOSHO DDS (NPI 1205145976) is an individual dentist in Chicago, Illinois, licensed in Illinois (019029289) and active in the NPI registry since September 2010. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1205145976
Entity TypeIndividualFemale
Primary Taxonomy122300000X
Provider Legal NameABIDEMI GBOTOSHOCredential: DDS
Location Address1650 S ALBANY AVEChicago, IL 60623-2251
Mailing Address1650 S Albany AveChicago, IL 60623-2251 · (347) 416-3147
Phone(347) 416-3147
Sole ProprietorNo
Enumeration DateSeptember 29, 2010
Last NPPES UpdateApril 23, 20212 updates tracked since enumeration
NPPES CertifiedApril 23, 2021
✔ NPI 1205145976 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in IL · 019029289
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
Also ListedDentist · General PracticeTaxonomy 1223G0001X · License 0026015 (TX)
1650 S ALBANY AVE, Chicago, IL 60623
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware, Anthem Blue Cross and Blue Shield and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Abidemi Gbotosho Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Abidemi Gbotosho reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Cook County
1.3 mi
Primary Care
2424 S PULASKI RD
Chicago, IL 60623
  • Reassigned Medicare billing, Illinois enrollment
  • 1,047 clinicians in this Medicare group
NPI 1861512667 (773) 521-0750

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60623 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.06 typical visit price
range $60.08 – $183.39
Typical copayment $23.51 (range $15.02 – $45.84)
Most-billed visit code 99203
Established Patient
$74.80 typical visit price
range $18.97 – $148.12
Typical copayment $18.70 (range $4.74 – $37.03)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Abidemi Gbotosho's NPI number?

The NPI number for Abidemi Gbotosho is 1205145976. It was assigned to this individual provider in the NPPES registry on September 29, 2010.

Where is Abidemi Gbotosho located?

Abidemi Gbotosho practices at 1650 S Albany Ave, Chicago, IL 60623. The listed phone number is (347) 416-3147.

What is Abidemi Gbotosho's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Abidemi Gbotosho enrolled in Medicare?

Yes. Abidemi Gbotosho is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Abidemi Gbotosho's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Abidemi Gbotosho reassigns Medicare benefits to Cook County (Chicago, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Abidemi Gbotosho's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Abidemi Gbotosho accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 3 other insurers list Abidemi Gbotosho as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Abidemi Gbotosho was last updated on April 23, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.