Olitha Jamesetta Fofana, AGPCNP-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

CNP 3783 Issued in MN

Practice address

10911 Rhode Island Cir N
Champlin, MN 55316-3256

Phone

(763) 493-2947

NPI assigned

Mar 24, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Olitha Jamesetta Collins Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of South Alabama College of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Group Health, Inc.

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1710924683
  Medicare reassignment Care Compare group NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment Care Compare group NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  MN

  Medicare reassignment NPD
• Group Health Plan, Inc.

  • Health Service Clinic/Center
  • Anoka, MN
  • NPI 1962704346
  NPD
• Group Health, Inc.

  • General Practice Dentistry
  • Saint Paul, MN
  • NPI 1952042053
  NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593
  NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • Minneapolis, MN
  • NPI 1912315144
  NPD
• Group Health, Inc.

  • Multi-Specialty Clinic/Center
  • Hudson, WI
  • NPI 1427420181
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • Maple Grove, MN
  • NPI 1174980692
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1194113217
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1245615772
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • Mental Illness Community Based Residential Treatment Facility
  • St Louis Park, MN
  • NPI 1578717336

  Hospital

  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1649220724
  Care Compare affiliation
• Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • St Louis Park, MN
  • NPI 1942585286
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427155200000",
    "number": "1013301407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10911 RHODE ISLAND CIR N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553163256",
            "telephone_number": "763-493-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10911 RHODE ISLAND CIR N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553163256",
            "telephone_number": "763-493-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOFANA",
        "first_name": "OLITHA",
        "middle_name": "JAMESETTA",
        "name_prefix": "Mrs.",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-24",
        "last_updated": "2015-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "CNP 3783",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "CNP 3783",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MN",
            "license": "CNP 3783",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OLITHA",
            "last_name": "COLLINS",
            "middle_name": "JAMESETTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ellen Fastner, NP
• Diane Kay Felton, PHD, LP
• Pamela Fleagle, MA
• Desare Fleming
• Ibrahim Bangaly Fofana, DRIVER
• Kenneth Fox
• Nicole Franczak
• Mandy Fredrickson
• Gabby Care Homes LLC
• Gabby Care Homes LLC

• Adult Health Nurse Practitioner in Champlin, MN
• Providers in Champlin, MN by specialty
• Adult Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.