ADEBOLA O ADESANYA, MD — NPI 1124080288 (Board-Certified Anesthesiologist & Interventional Pain Specialist in FORT WORTH, TX)

CMS-1500 Box 24J / 33a • NPI

1124080288

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

207LC0200X (CMS 05)

Board-Certified Anesthesiologist & Interventional Pain Specialist

Box 32 Service Location & ZIP+4

3101 N TARRANT PKWY, FORT WORTH, TX, 76177-8601

✓ 9-Digit EDI 837 ZIP+4 (76177-8601)

Practice Phone & Referral Fax

(817) 639-1000

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1124080288 (ADEBOLA O ADESANYA, MD) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1124080288` (NPI-1 Individual Practitioner)
Provider / Legal Name	ADEBOLA O ADESANYA, MD
Plain-English Specialty	Board-Certified Anesthesiologist & Interventional Pain Specialist NUCC Code: `207LC0200X` (Anesthesiology, Critical Care Medicine)
Certifying / Licensing Body	American Board of Anesthesiology (ABA)
Practice Location Address	3101 N TARRANT PKWY, FORT WORTH, TX, 76177-8601
Practice Telephone / Fax	Tel: (817) 639-1000
Administrative Mailing Address	4020 N MACARTHUR BLVD STE 122-228, IRVING, TX, 75038-6419
Enumeration & Last Sync	Enumerated: 2006-04-04 \| CMS Record Updated: 2020-08-05

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

3101 N TARRANT PKWY, FORT WORTH, TX, 76177-8601

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Plain-English Taxonomy & CMS Crosswalk (207LC0200X)

What Does Taxonomy Code 207LC0200X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207LC0200X translates to:
"Board-Certified Anesthesiologist & Interventional Pain Specialist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 05 (Physician/Anesthesiology)
Certifying / Accrediting Authority: American Board of Anesthesiology (ABA)
Clinical Scope: Pre-surgical anesthesia evaluation, obstetric labor epidural care, or interventional spine and nerve block procedures for chronic pain.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ADEBOLA O ADESANYA, MD)

Typical CPT / Diagnostic Procedures:

General Endotracheal Anesthesia & Total Intravenous Anesthesia (TIVA)
Ultrasound-Guided Peripheral Nerve Blocks & Labor Epidural Analgesia
Fluoroscopic Epidural Steroid Injections & Facet Joint Blocks

Common Therapeutic Classes:

Propofol, Sevoflurane, Rocuronium & Sugammadex
Bupivacaine, Lidocaine & Ropivacaine Regional Anesthetics

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207L00000X` — Anesthesiology Plain English: Board-Certified Anesthesiologist & Interventional Pain Specialist	State: TX \| License: `K1331` \| Primary: Secondary
`207R00000X` — Internal Medicine Plain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)	State: TX \| License: `K1331` \| Primary: Secondary
`207LC0200X` — Anesthesiology, Critical Care Medicine Plain English: Board-Certified Anesthesiologist & Interventional Pain Specialist	State: TX \| License: `K1331` \| Primary: Yes (Primary)

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ADEBOLA O ADESANYA, MD (NPI #1124080288)