Individual provider Active NPI

Idowu Awolusi

  • Family Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1669036836
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R168616 Issued in MD
Practice address
2200 Kernan Dr
Baltimore, MD 21207-6665
Phone
(443) 977-0313
NPI assigned
Apr 23, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X F04190184 MD
Family Nurse Practitioner 363LF0000X R168616 MD Primary

Addresses

Primary practice location

2200 Kernan Dr
Baltimore, MD 21207-6665

Mailing address

3969 Whispering Meadow Dr
Randallstown, MD 21133-4342
Phone (443) 977-0313

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200203002137 MD Practitioner - Nurse Practitioner 3375979776 Reassigns benefits to 2 organizations
I20200210000072 DC Practitioner - Nurse Practitioner 3375979776 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Maryland Medical First PAGroup PAC ID 1850329715, 26 clinicians

Practice addresses (Care Compare)

8901 Clement Ave
Parkville, MD 21234-2603
Phone (410) 661-4670

Hospital & facility affiliations

  • Bayada Home Health Care, Inc. Home health agency, Towson, MD, CCN 217101
  • Gilchrist Hospice Care, Inc Hospice, Hunt Valley, MD, CCN 211526

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F04190184MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Eldercare Physician Services LLC Multi-Specialty CurrentSince Feb 14, 2023 Accepting new patients
HCR Manorcare Medical Services of Florida LLC Multi-Specialty CurrentSince May 3, 2022 Accepting new patients
Optimize Medical Group Multi-Specialty CurrentSince Nov 9, 2019 Accepting new patients
Maryland Medical First P.a. Multi-Specialty CurrentSince Jul 10, 2023 Accepting new patients
Post Acute Health Care Services LLC Multi-Specialty Past Accepting new patients
Viewpoint Wellness LLC Multi-Specialty PastSince Dec 13, 2020 Accepting new patients

Locations

4669 Falls Rd
Baltimore, MD 21209
Phone (410) 662-8606

1051 Brightseat Rd
Landover, MD 20785
Phone (240) 487-4400

8901 Clement Ave
Parkville, MD 21234
Phone (410) 661-4670

1801 Wentworth Rd
Parkville, MD 21234
Phone (410) 661-5717

8909 Reisterstown Rd
Pikesville, MD 21208
Phone (410) 415-5600

1232 Race Rd
Ste 403
Rosedale, MD 21237
Phone (480) 878-7806

3227 Bel Pre Rd
Silver Spring, MD 20906
Phone (301) 871-2000

L2540 Maryland
Columbus, OH 43260

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BAFGCA

Organizations & group practices 6

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

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": "1555977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1669036836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3969 WHISPERING MEADOW DR",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211334342",
            "telephone_number": "443-977-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 KERNAN DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212076665",
            "telephone_number": "443-977-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AWOLUSI",
        "first_name": "IDOWU",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-23",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "F04190184",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R168616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.