NPIMap

Individual provider Active NPI

Ismailu O Agbaje, PHD MD

  • Physical Medicine & Rehabilitation Physician
  • Newnan, GA
National Provider Identifier
1336190776
Registry record updated Oct 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
72872 Issued in GA
Practice address
2101 Newnan Crossing Blvd E
Newnan, GA 30265-2406
Phone
(812) 272-4497
Fax
(419) 828-8218
NPI assigned
May 12, 2006
Last updated
Oct 8, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 72872 GA Primary

Addresses

Primary practice location

2101 Newnan Crossing Blvd E
Newnan, GA 30265-2406

Mailing address

PO Box 73200
Newnan, GA 30271-3200
Phone (812) 272-4497

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20150205002586 GA Practitioner - Physical Medicine and Rehabilitation 2163491218 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Medical College of Wisconsin, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2101 Newnan Crossing Blvd E
Newnan, GA 30265-2406
Phone (812) 272-4497

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
72872GAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Applebaum Physiatry PLLC Physical Medicine & Rehabilitation CurrentSince Jun 13, 2024 Accepting new patients
Amanu Physical Medicine & Rehabilitation, LLC Physical Medicine & Rehabilitation CurrentSince Oct 1, 2005 Accepting new patients
Physical Medicine Associates of N.W. Ohio, Inc. Physical Medicine & Rehabilitation PastSince Aug 1, 1996 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Nursing Home Physician Group PLLC Physical Medicine & Rehabilitation Past Accepting new patients

Locations

1800 Phoenix Blvd
Ste 12812
Atlanta, GA 30349
Phone (678) 525-7787

7560 Butner Rd
Fairburn, GA 30213
Phone (770) 306-7878

1267 Highway 54 W
Ste 5200
Fayetteville, GA 30214
Phone (770) 460-9777

2101 Newnan Crossing Blvd E
Newnan, GA 30265
Phone (678) 552-6200

128 S East St
Unit 1109
Crown Point, IN 46308

658 W Market St
Ste 117
Lima, OH 45801
Phone (419) 222-3482

120 12th Street Ext
#A
Princeton, WV 24740
Phone (304) 487-2040

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15723/brand/1/csg/1/fhir/r4

Organizations & group practices 5

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 6

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602115200000",
    "number": "1336190776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73200",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302713200",
            "telephone_number": "812-272-4497",
            "fax_number": "419-828-8218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 NEWNAN CROSSING BLVD E",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652406",
            "telephone_number": "812-272-4497",
            "fax_number": "419-828-8218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGBAJE",
        "first_name": "ISMAILU",
        "middle_name": "O",
        "credential": "PHD MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GA",
            "license": "72872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newnan, GA

Sources for this page

Verify at the official NPI Registry.