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DR. OLATOKUNBO EFUNSAMI SOYODE-ETOMI M.D.
NPI 1326132804
Community/Behavioral Health in Gastonia, NC

Active since October 02, 2006PECOS Enrolled
549 COX RD, GASTONIA, NC 28054(704) 865-1558(704) 865-9908 Get Directions Write a Review

NPPES record last updated: October 20, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 29, 2020, Jun 21, 2018 (2 updates tracked since 2018).

About Dr. Olatokunbo Efunsami Soyode-etomi M.d. NPPES

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

DR. OLATOKUNBO EFUNSAMI SOYODE-ETOMI M.D. (NPI 1326132804) is an individual community/behavioral health provider in Gastonia, North Carolina, licensed in North Carolina (9300327) and active in the NPI registry since October 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1326132804
Entity TypeIndividualFemale
Primary Taxonomy251S00000X
Provider Legal NameDR. OLATOKUNBO EFUNSAMI SOYODE-ETOMICredential: M.D.
Location Address549 COX RDGastonia, NC 28054-0628
Mailing Address500 Archdale DrCharlotte, NC 28217-4217 · (704) 332-9001
Phone(704) 865-1558
Fax(704) 865-9908
Sole ProprietorYes
Enumeration DateOctober 2, 2006
Last NPPES UpdateOctober 20, 20252 updates tracked since enumeration
NPPES CertifiedOctober 20, 2025
✔ NPI 1326132804 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity/Behavioral HealthAgencies
Taxonomy Code251S00000X
License✔ Licensed in NC · 9300327
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
549 COX RD, Gastonia, NC 28054
Open in Google Maps ↗

Other Identifiers 1

Medicaid8930894NC

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Olatokunbo Efunsami Soyode-etomi M.d. 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 Reassignments

2

Medicare enrollment records show Olatokunbo Soyode-etomi reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Novant Health Medical Group, LLC
16 mi
Pain Medicine
773 STOCKBRIDGE DR
Fort Mill, SC 29708
  • Reassigned Medicare billing, South Carolina enrollment
  • 28 clinicians in this Medicare group
NPI 1528923091 (803) 992-8030
First Care Medical Clinic
22 mi
Internal Medicine
1462 CONSTITUTION BLVD
Rock Hill, SC 29732
  • Reassigned Medicare billing, South Carolina enrollment
  • 9 clinicians in this Medicare group
NPI 1881989192 (704) 291-9267

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

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARGARET REVELS LPN
Licensed Practical Nurse
549 COX RD
GASTONIA, NC 28054
Gaston County (707) 865-1558
GENESISHOUSE, INC.
Case Management
549 COX RD, SUITE A
GASTONIA, NC 28054
Gaston County (704) 852-3778
DEANNA PEARSON LPN
Licensed Practical Nurse
549 COX RD
GASTONIA, NC 28054
Gaston County (704) 865-1558
TONYA COSTNER
Counselor (Addiction (Substance Use Disorder))
549 COX RD
GASTONIA, NC 28054
Gaston County (704) 332-9001
ROSE WATKINS LPN
Licensed Practical Nurse
549 COX RD
GASTONIA, NC 28054
Gaston County (704) 865-1558
MARY-JACQUELINE DELORES KERSEY LCSWA
Counselor (Addiction (Substance Use Disorder))
549 COX RD
GASTONIA, NC 28054
Gaston County (704) 332-9001
DR. LYSSA MARIE ISRAEL PH.D.
Psychologist (Clinical)
549 COX RD
GASTONIA, NC 28054
Gaston County (704) 852-3778
MS. LASHAWN COOLEY LCSWA
Social Worker (Clinical)
549 COX RD
GASTONIA, NC 28054
Gaston County (704) 865-1558

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 Olatokunbo Soyode-etomi's NPI number?

The NPI number for Olatokunbo Soyode-etomi is 1326132804. It was assigned to this individual provider in the NPPES registry on October 2, 2006.

Where is Olatokunbo Soyode-etomi located?

Olatokunbo Soyode-etomi practices at 549 Cox Rd, Gastonia, NC 28054. The listed phone number is (704) 865-1558.

What is Olatokunbo Soyode-etomi's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

Is Olatokunbo Soyode-etomi enrolled in Medicare?

Yes. Olatokunbo Soyode-etomi is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Olatokunbo Soyode-etomi's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Olatokunbo Soyode-etomi reassigns Medicare benefits to 2 organizations: Novant Health Medical Group, LLC (Fort Mill, SC) and First Care Medical Clinic (Rock Hill, SC). Each 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 Olatokunbo Soyode-etomi's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Olatokunbo Soyode-etomi was last updated on October 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.