Active NPI
Adebola Ezetendu
- Primary Care Nurse Practitioner
- Parma, OH
National Provider Identifier
1285224618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- APRN.CNP.0028258
- Practice address
- 5500 Ridge Rd Ste 120
Parma, OH 44129-2367 - Phone
- (216) 202-6417
- NPI assigned
- Jan 20, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | APRN.CNP.0028258 | OH | Primary |
Addresses
Primary practice location
5500 Ridge Rd Ste 120
Parma, OH 44129-2367
Mailing address
5479 Stone Creek Dr
Solon, OH 44139-1679
Phone (281) 948-2545
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240429002453 | OH | Order and Referring Only - Nurse Practitioner | 2365882081 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611100800000",
"number": "1285224618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5479 STONE CREEK DR",
"city": "SOLON",
"state": "OH",
"postal_code": "441391679",
"telephone_number": "281-948-2545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5500 RIDGE RD STE 120",
"city": "PARMA",
"state": "OH",
"postal_code": "441292367",
"telephone_number": "216-202-6417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZETENDU",
"first_name": "ADEBOLA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-20",
"last_updated": "2021-01-20",
"certification_date": "2021-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "OH",
"license": "APRN.CNP.0028258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Parma, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.