SAMUEL ADEKUNLE ADEFEYISAN MD
NPI 1568673556
Anesthesiology in Grand Prairie, TX
About Samuel Adekunle Adefeyisan Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMUEL ADEKUNLE ADEFEYISAN MD (NPI 1568673556) is an individual anesthesiology provider in Grand Prairie, Texas, licensed in Georgia (062934) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS, is affiliated with Piedmont Columbus Regional Midtown, and maintains 2 additional practice locations.
NPPES Registry Identity
Specialties & Licenses 3
Secondary Practice Locations 2
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Samuel Adekunle Adefeyisan Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
6Medicare enrollment records show Samuel Adefeyisan reassigns Medicare billing to 6 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Richardson, TX 75082
- Reassigned Medicare billing, North Carolina and South Carolina enrollments
- 493 clinicians in this Medicare group
Columbus, GA 31901
- Reassigned Medicare billing, Georgia enrollment
- 165 clinicians in this Medicare group
Stone Mountain, GA 30087
- Reassigned Medicare billing, Georgia enrollment
- 650 clinicians in this Medicare group
Seneca, SC 29678
- Reassigned Medicare billing, South Carolina enrollment
- Medicare enrollment name: Prisma Health University Medical Group
- 3,281 clinicians in this Medicare group
Mccormick, SC 29835
- Reassigned Medicare billing, South Carolina enrollment
- 560 clinicians in this Medicare group
Bamberg, SC 29003
- Reassigned Medicare billing, South Carolina enrollment
- 2,389 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Piedmont Columbus Regional Midtown
Acute Care Hospitals · Columbus, GAFrequently 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 Samuel Adefeyisan's NPI number?
The NPI number for Samuel Adefeyisan is 1568673556. It was assigned to this individual provider in the NPPES registry on May 24, 2007.
Where is Samuel Adefeyisan located?
Samuel Adefeyisan practices at 4314 Clayton St, Grand Prairie, TX 75052. The listed phone number is (214) 708-9590.
What is Samuel Adefeyisan's specialty?
The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.
Is Samuel Adefeyisan enrolled in Medicare?
Yes. Samuel Adefeyisan is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Samuel Adefeyisan's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Adefeyisan reassigns Medicare benefits to 6 organizations: Medstream Anesthesia PLLC (Richardson, TX), Hospitalist Medicine Physicians Of Georgia - Tcs, PC (Columbus, GA), American Anesthesiology Associates Of Georgia, LLC (Stone Mountain, GA), Ghs Partners In Health, Inc. (Seneca, SC), Self Medical Group (Mccormick, SC) and 1 more organization, listed in the Medicare section above. 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 Samuel Adefeyisan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Samuel Adefeyisan affiliated with any hospitals?
According to CMS data, Samuel Adefeyisan is affiliated with Piedmont Columbus Regional Midtown.
When was this NPI record last updated?
The NPPES record for Samuel Adefeyisan was last updated on December 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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.
# Samuel Adekunle Adefeyisan, MD · NPI 1568673556
Anesthesiology physician in Grand Prairie, Texas. Individual provider, active in the CMS NPPES registry since May 24, 2007.
## Identity
- **NPI:** 1568673556 (Entity type: Individual)
- **Enumerated:** May 24, 2007
- **Primary specialty:** Anesthesiology · taxonomy 207L00000X
- **State license:** 062934 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 4314 CLAYTON ST, Grand Prairie, TX 75052-3433
- **Phone:** (214) 708-9590
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 6 organizations under Medicare reassignment (form CMS-855R): Medstream Anesthesia PLLC (NPI 1649616160, Richardson, TX); Hospitalist Medicine Physicians Of Georgia - Tcs, PC (NPI 1033926191, Columbus, GA); American Anesthesiology Associates Of Georgia, LLC (NPI 1528068673, Stone Mountain, GA); Ghs Partners In Health, Inc. (NPI 1457730814, Seneca, SC); Self Medical Group (NPI 1629382056, Mccormick, SC); and 1 more · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1986
## Record status
- **NPPES last updated:** December 16, 2024
- **Other identifiers:** Medicaid Q46839 (SC)
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Source: [NPI Profile](https://npiprofile.com/npi/1568673556) · Data from the CMS NPPES public registry.