Opeyemi Boyede Ajibola – Family Nurse Practitioner

Key facts

NPI: 1083466403
Entity type: Individual (NPI type 1)
Primary specialty: Family Nurse Practitioner 363LF0000X
License: 1156415 (TX)
Practice address: 33300 Egypt LN Ste C500
Magnolia, TX 77354-2873
Phone: (281) 570-5078
NPI assigned: Apr 2, 2024
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

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.

Comprehensive Rehab Consultants PLLC Physical Medicine & Rehabilitation Physician · Middle River, MD · NPI 1710529771

Medicare reassignment Care Compare group NPD FAMILY · TX

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2023
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Comprehensive Rehab Consultants PLLC (251 clinicians)

Practice addresses (Care Compare)

250 School St
Tomball, TX 77375-4701
Phone (281) 516-7929

Medicare participation

Medicare fee-for-service enrollment: Enrolled in TX
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20240531002486	TX	Practitioner - Nurse Practitioner	3779925045	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Nurse Practitioner

State licenses

License	State	Type	Specialty
1156415	TX	MD	Family Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Comprehensive Rehab Consultants PLLC	Family	Current since Apr 29, 2024	Accepting new patients

Locations

415 W Golf Rd
Ste 26
Arlington Hts, IL 60005

940 York Dr
Desoto, TX 75115
Phone (972) 331-4554

8550 Jason St
Houston, TX 77074
Phone (346) 231-7500

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Primary Care Clinic/Center	261QP2300X
Family Nurse Practitioner	363LF0000X	1156415	TX	Yes

Addresses

Primary practice location

33300 Egypt LN Ste C500
Magnolia, TX 77354-2873

Mailing address

33300 Egypt LN
Magnolia, TX 77354-2739
Phone (936) 650-7553

Other providers in Magnolia, TX

Agilitas USA, Inc
Alia Ahmed, BCBA
Hylary Ahrendt, BCBA
Aj Marshall Medical, PLLC
Aj Marshall, LLC
Omosefe Jumoke Akojenu, RN
Al Squared LLC
Sandra Adela Alaniz, MEDICAL INTERPRETER
Hunter Ryan Alexander, BCBA, LBA
Jacquingamen Alexander

All providers in Magnolia, TX · Family Nurse Practitioner in Texas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (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.