NPIMap

Individual provider Active NPI

Olutayo T Olabige, M.D.

  • Nephrology Physician
  • Crystal River, FL
National Provider Identifier
1306046214
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME119764 Issued in FL
Practice address
6218 W Corporate Oaks Dr
Crystal River, FL 34429-8723
Phone
(352) 346-3127
Fax
(352) 581-6226
NPI assigned
Jul 19, 2007
Last updated
Aug 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 48779 KY
Nephrology Physician 207RN0300X 01068818A IN
Nephrology Physician 207RN0300X ME119764 FL Primary

Addresses

Primary practice location

6218 W Corporate Oaks Dr
Crystal River, FL 34429-8723

Mailing address

PO Box 141032
Gainesville, FL 32614-1032
Phone (646) 623-8106

Other practice location 1

3600 NW 43rd St Ste D2
Gainesville, FL 32606-8127
Phone (352) 646-3127

Other practice location 2

1548B S Water St
Starke, FL 32091-4511
Phone (352) 346-3127

Other identifiers 3

IdentifierTypeStateIssuer
201272180MedicaidIN
7100389860MedicaidKY
019517200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170301002211 FL Practitioner - NephrologyPractitioner - Internal Medicine 7012002710 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6218 W Corporate Oaks Dr
Crystal River, FL 34429-8723
Phone (646) 623-8106

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01068818AINMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa General Hospital Current Accepting new patients
West Florida Medical Associates P a Internal Medicine CurrentSince Feb 12, 2019 Accepting new patients
West Florida Medical Associates, PA Internal Medicine CurrentSince Feb 12, 2019 Accepting new patients
Arnot Ogden Medical Center Internal Medicine Past Accepting new patients
Hospitalist Medicine Physicians of Albany County, PLLC Internal Medicine Past Accepting new patients
Atlantic Professional Services of Rhode Island Incorporated Past Accepting new patients

Locations

3404 N Lecanto Hwy
Ste A
Beverly Hills, FL 34465
Phone (352) 513-4867

6201 N Suncoast Blvd
Crystal River, FL 34428
Phone (352) 527-0671

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: oolabige296940@direct.tgh.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1306046214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 141032",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326141032",
            "telephone_number": "646-623-8106",
            "fax_number": "352-581-6226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6218 W CORPORATE OAKS DR",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344298723",
            "telephone_number": "352-346-3127",
            "fax_number": "352-581-6226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 NW 43rd St Ste D2",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326068127",
            "country_code": "US",
            "telephone_number": "352-646-3127",
            "fax_number": "352-581-6226",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1548B S Water St",
            "address_purpose": "LOCATION",
            "city": "Starke",
            "state": "FL",
            "postal_code": "320914511",
            "country_code": "US",
            "telephone_number": "352-346-3127",
            "fax_number": "352-581-6226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLABIGE",
        "first_name": "OLUTAYO",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-19",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "48779",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01068818A",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME119764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201272180",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100389860",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019517200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal River, FL

Sources for this page

Verify at the official NPI Registry.