Individual provider Active NPI

Olufunke Elizabeth Owolabi

  • Family Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1700440823
Registry record updated Dec 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F04190305 Issued in IN
Practice address
4921 Aspen Crest LN
Indianapolis, IN 46254-9514
Phone
(317) 666-5050
NPI assigned
Apr 24, 2019
Last updated
Dec 2, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F04190305 IN Primary

Addresses

Primary practice location

4921 Aspen Crest LN
Indianapolis, IN 46254-9514

Mailing address

1119 Keystone Way
Ste 201B
Carmel, IN 46032-3356
Phone (317) 214-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20191212001632 IN Practitioner - Nurse Practitioner 5698108264 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Illinois Medical College, 2018
Medicare assignment
May accept Medicare assignment
Group practices
Altea Medical Indiana PCGroup PAC ID 4183064389, 24 clinicians
Post Acute Medical PLLCGroup PAC ID 5193156115, 433 clinicians

Practice addresses (Care Compare)

2350 Taft St
Gary, IN 46404-3349
Phone (219) 977-2600

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F04190305INMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Post Acute Medical PLLC CurrentSince Mar 28, 2024 Accepting new patients
Altea Medical Indiana PC CurrentSince Feb 26, 2024 Accepting new patients

Locations

400 E Rivulon Blvd
Ste 103
Gilbert, AZ 85297

1707 Bethany Rd
Anderson, IN 46012
Phone (765) 393-8783

2350 Taft St
Gary, IN 46404
Phone (219) 944-2677

3518 S Lafountain St
#3803
Kokomo, IN 46902
Phone (765) 453-4667

1101 E Coolspring Ave
Michigan City, IN 46360
Phone (219) 874-5211

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": "1556064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575244800000",
    "number": "1700440823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 KEYSTONE WAY",
            "address_2": "STE 201B",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460323356",
            "telephone_number": "317-214-2100",
            "fax_number": "317-214-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 ASPEN CREST LN",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462549514",
            "telephone_number": "317-666-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWOLABI",
        "first_name": "OLUFUNKE",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-24",
        "last_updated": "2019-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "F04190305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.