Individual provider Active NPI

Omoronke Adegbuji, FNP-C

  • Primary Care Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1649493537
Registry record updated Jun 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
RN161498 Issued in GA
Practice address
1000 Johnson Ferry Road
Atlanta, GA 30342
Phone
(770) 645-9181
Fax
(770) 645-8455
NPI assigned
Apr 10, 2007
Last updated
Jun 26, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN161489 GA
Family Nurse Practitioner 363LF0000X RN161498 GA
Primary Care Nurse Practitioner 363LP2300X RN161498 GA Primary

Addresses

Primary practice location

1000 Johnson Ferry Road
Atlanta, GA 30342

Mailing address

3155 N Point Pkwy
Attn Credentialing Dept, Building F, Suite 100
Alpharetta, GA 30005
Phone (770) 645-9181

Other identifiers 1

IdentifierTypeStateIssuer
486548249AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN161489GAMDNurse Practitioner
RN161498GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
David E Kim MD PC PastSince Jul 1, 2019 Accepting new patients
The Healthcaring Clinic of Georgia, LLC Family PastSince May 7, 2013 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1649493537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3155 N POINT PKWY",
            "address_2": "ATTN CREDENTIALING DEPT, BUILDING F, SUITE 100",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "30005",
            "telephone_number": "770-645-9181",
            "fax_number": "770-645-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY ROAD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30342",
            "telephone_number": "770-645-9181",
            "fax_number": "770-645-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEGBUJI",
        "first_name": "OMORONKE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN161489",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN161498",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN161498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "486548249A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.