Olatokunbo Adepoju
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Edgewood, MD
NPI 1245000355 · NPPES record last updated Jan 18, 2024
Key facts
- NPI
- 1245000355
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- R240738 (MD)
- Practice address
- 702 Saint Peters CT
Edgewood, MD 21040-3829 - Phone
- (443) 850-4376
- NPI assigned
- Jan 9, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Advantage Psychiatric Services LLC
Practice addresses (Care Compare)
5024 Campbell Blvd
Suite a
Nottingham, MD 21236-5974
Phone 4106863629101
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- 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 |
|---|---|---|---|---|
| I20250313000220 | MD | Practitioner - Nurse Practitioner | 2264953728 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R240738 | MD | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advantage Psychiatric Services LLC | Current |
Accepting new patients | |
| Advantage Psychiatric Services LLC | Current | Accepting new patients | |
| Castle of Grace Mental Healthcare Services LLC | Psychiatric/Mental Health | Current |
Accepting new patients |
| Advantage Psychiatric Services LLC | Past | Accepting new patients | |
| Advantage Psychiatric Services LLC | Past | Accepting new patients | |
| Advantage Psychiatric Services LLC | Past | Accepting new patients |
Locations
306 W Pulaski Hwy
Elkton, MD 21921
Phone 4106863629 ext. 417
253 Lewis Ln
Ste 101
Havre de Grace, MD 21078
Phone (321) 474-4661
910 Revolution St
Hvre de Grace, MD 21078
Phone (410) 919-9665
5024 Campbell Blvd
Ste A
Nottingham, MD 21236
Phone 4106863629110
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R240738 | MD | Yes |
Addresses
Primary practice location
702 Saint Peters CT
Edgewood, MD 21040-3829
Mailing address
702 Saint Peters CT
Edgewood, MD 21040-3829
Phone (443) 850-4376
Other providers in Edgewood, MD
- A Place for You, LLC
- Abundance of Care
- Acceptance Mental Health Care and Psychiatry, LLC
- Achieving Wellness
- Charlisa Feliesh Addison
- Affectionate Hands Family Care
- Suzan M Alnabelsi
- Amazing Health Care Services Inc
- Anew Homecare Services LLC
- Angel Home Care, LLC
All providers in Edgewood, MD · Psychiatric/Mental Health Nurse Practitioner in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 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.