Jacob K Agamasu, MD
Individual provider Active NPI Cardiovascular Disease Physician · Lake Mary, FL
NPI 1194774604 · NPPES record last updated Nov 20, 2024
Key facts
- NPI
- 1194774604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- ME85101 (FL)
- Practice address
- 731 Stirling Center PL Unit 1911
Lake Mary, FL 32746-5209 - Phone
- (407) 804-9616
- Fax
- (407) 804-8331
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- George Washington University School of Medicine, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Florida Hospital Healthcare Partners, Inc
Practice addresses (Care Compare)
301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167
Phone (386) 231-6000
731 Stirling Ctr PL
Lake Mary, FL 32746-5209
Phone (407) 804-9616
Hospital & facility affiliations
- Central Florida Lake Monroe Hospital
- Adventhealth Fish Memorial
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Coronary angioplasty and stenting | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031203000695 | FL | Practitioner - Cardiovascular Disease (Cardiology) | 6901701846 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles (5 of 7)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellnessclinic on Wheels LLC | Current |
Accepting new patients | |
| Florida Hospital Healthcare Partners, Inc | Current |
Accepting new patients | |
| Jacob K Agamasu MD PA | Cardiovascular Disease | Past | Accepting new patients |
| Cardiology Care Center PA | Cardiovascular Disease | Past | Accepting new patients |
| Eze D. Uche, M.D., PA | Specialist | Past | Accepting new patients |
Locations
301 Memorial Medical Pkwy
Holly Hill, FL 32117
Phone (386) 231-3906
1055 Saxon Blvd
Orange City, FL 32763
Phone (386) 917-5000
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | ME85101 | FL | Yes |
Addresses
Primary practice location
731 Stirling Center PL Unit 1911
Lake Mary, FL 32746-5209
Mailing address
731 Stirling Center PL Unit 1911
Lake Mary, FL 32746-5209
Phone (407) 804-9616
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13045 | Other | FL | BC |
Other providers in Lake Mary, FL
- Adventist Health System/Sunbelt, Inc
- Adventist Health System/Sunbelt, Inc.
- Adventist Health System/Sunbelt, Inc.
- Affordable Dentures & Implants - Lake Mary II, P.a.
- Affordable Dentures & Implants - Lake Mary, P.a.
- Sumita Aggarwal
- Ayesha R Ahmar
- Abdul Quyyum Ahmed
- Rafat Ahmed
- Kelly Ann Aicher
All providers in Lake Mary, FL · Cardiovascular Disease Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 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.