Amen C Otunba, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024186850 Issued in VA

Practice address

9500 Richmond Hwy
Lorton, VA 22079-2124

Phone

(571) 800-8915

Fax

(833) 954-5512

NPI assigned

Mar 30, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, DC2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sentara Northern Virginia Medical Center Hospital, Woodbridge, VA, CCN 490113

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: aotunba848707@direct.sentara.net

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

• Sentara Medical Group

  • Family Medicine Physician
  • Norfolk, VA
  • NPI 1265485270

  DC

  Medicare reassignment Care Compare group NPD
• Gastroenterology Associates of Northern Virginia, LLC

  • Gastroenterology Physician
  • Fairfax, VA
  • NPI 1205884368

  DC

  Medicare reassignment NPD
• Mednovations LLC

  • Primary Care Clinic/Center
  • Woodbridge, VA
  • NPI 1013402593
  Medicare reassignment NPD
• Old Dominion Anesthesia LLC

  • Anesthesiology Physician
  • Charlottesville, VA
  • NPI 1902248677
  NPD (past)

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

• Potomac Hospital Corporation of Prince William

  dba Sentara Northern Virginia Medical Center

  • General Acute Care Hospital
  • Woodbridge, VA
  • NPI 1548366404
  Care Compare affiliation

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

{
    "created_epoch": "1680134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1043914245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3360 POST OFFICE RD UNIT 1796",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221958052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 RICHMOND HWY",
            "city": "LORTON",
            "state": "VA",
            "postal_code": "220792124",
            "telephone_number": "571-800-8915",
            "fax_number": "833-954-5512"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12255 Fair Lakes Pkwy",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220333952",
            "country_code": "US",
            "telephone_number": "571-458-7279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OTUNBA",
        "first_name": "AMEN",
        "middle_name": "C",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-30",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024186850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon O'Connor, OTR/L
• Irene Osaro Odigie, MD
• Puja Ohri, D.D.S.
• On the Go Medical Transportation LLC (On The Go Transportation LLC)
• One in a Millie Home Health Care
• Edna Pahlavani, D.D.S
• Pamoja Rooted LLC
• Vivian Seonghwa Park
• Lily Anne Parris, PTA
• Nolan Paresh Patel, DO

• Family Nurse Practitioner in Lorton, VA
• Providers in Lorton, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; 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.