Individual provider Active NPI

Oluyemi Shorunke

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1053860148
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
000000 Issued in TX
Practice address
3840 Hulen St
Fort Worth, TX 76107-7277
Phone
(817) 569-4039
NPI assigned
Sep 29, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 000000 TX Primary

Addresses

Primary practice location

3840 Hulen St
Fort Worth, TX 76107-7277

Mailing address

PO Box 2603
Fort Worth, TEXAS 76113
UM
Phone (972) 890-6237

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20161214000129 TX Practitioner - Nurse Practitioner 1052691839 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acclaim Physician Group IncGroup PAC ID 4587963582, 520 clinicians

Practice addresses (Care Compare)

1350 S Main St
Suite 1600
Fort Worth, TX 76104-7611
Phone (817) 702-9701

1350 S Main St FL
1 Healing Wings/Infectious Disease
Fort Worth, TX 76104-7611
Phone (817) 702-3701

1500 S Main St
Fort Worth, TX 76104-4917

1500 S Main St FL
1 Urgent Care Center
Fort Worth, TX 76104-4917
Phone (817) 702-1451

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.38 of 100Reported as group
Quality
80.41
Promoting interoperability
100
Improvement activities
40
Cost
78.69

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
000000TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
My Health My Resources of Tarrant County CurrentSince Jan 31, 2023 Accepting new patients
Evolve Psychiatry MD, Inc. CurrentSince Oct 1, 2022 Accepting new patients
Acclaim Physician Group, Inc CurrentSince Jul 17, 2017 Accepting new patients

Locations

1350 S Main St
Fl 1
Fort Worth, TX 76104
Phone (817) 702-3701

5300 Town and Country Blvd
Ste 240
Frisco, TX 75034
Phone (469) 833-3360

3840 Hulen St
Ft Worth, TX 76107
Phone (817) 569-4395

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1053860148",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "PO BOX 2603",
            "city": "FORT WORTH",
            "state": "TEXAS",
            "postal_code": "76113",
            "telephone_number": "972-890-6237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 HULEN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077277",
            "telephone_number": "817-569-4039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORUNKE",
        "first_name": "OLUYEMI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-29",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "000000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.