Individual provider Active NPI

Yetunde Precious Rotimi, MSN, FNP-BC, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Lanham, MD
National Provider Identifier
1083162960
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R205788 Issued in MD
Practice address
7404 Executive PL Ste 400L2
Lanham, MD 20706-2268
Phone
(240) 647-5702
Fax
(240) 433-3269
NPI assigned
Sep 20, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R205788 MD
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R205788 MD Primary

Addresses

Primary practice location

7404 Executive PL Ste 400L2
Lanham, MD 20706-2268

Mailing address

7404 Executive PL Ste 400L2
Lanham, MD 20706-2268
Phone (240) 647-5702

Other identifiers 1

IdentifierTypeStateIssuer
R205788OtherMDMD RN NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20240819002362 DC Practitioner - Nurse Practitioner 3375081516 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7404 Executive PL
Lanham, MD 20706-2268
Phone (240) 647-5702

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R205788MDMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Psychiatric/Mental Health CurrentSince Jul 9, 2024 Accepting new patients
Opollo Health and Wellness LLC CurrentSince Oct 11, 2024 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

7404 Executive Pl
Ste 400
Lanham, MD 20706
Phone (240) 639-4430

8300 Boone Blvd
Ste 500
Vienna, VA 22182
Phone (703) 884-2598

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.

NPI Registry JSON

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

{
    "created_epoch": "1474329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1083162960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7404 EXECUTIVE PL STE 400L2",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207062268",
            "telephone_number": "240-647-5702",
            "fax_number": "240-433-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7404 EXECUTIVE PL STE 400L2",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207062268",
            "telephone_number": "240-647-5702",
            "fax_number": "240-433-3269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTIMI",
        "first_name": "YETUNDE",
        "middle_name": "PRECIOUS",
        "credential": "MSN, FNP-BC, PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-20",
        "last_updated": "2024-08-06",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R205788",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R205788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD RN NUMBER",
            "identifier": "R205788",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lanham, MD

Sources for this page

Verify at the official NPI Registry.