Rakiya O Adediji, CRNP – Gerontology Registered Nurse

Key facts

NPI: 1720599772
Entity type: Individual (NPI type 1)
Primary specialty: Gerontology Registered Nurse 163WG0600X
License: 1-107325 (AL)
Practice address: 215 Winton M Blount Loop
Montgomery, AL 36117-3507
Phone: (334) 239-9480
Fax: (334) 239-7800
NPI assigned: Oct 17, 2017
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

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.

Ultracare Medical Services LLC Internal Medicine Physician · Montgomery, AL · NPI 1508192634

Medicare reassignment Care Compare group NPD AL

Hospital & facility affiliations 1

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

Health Care Authority for Baptist Health, an Affiliate of Uabhs General Acute Care Hospital · Montgomery, AL · NPI 1700977105

Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2017
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Ultracare Medical Services LLC (2 clinicians)

Practice addresses (Care Compare)

215 Winton Blount Loop
Montgomery, AL 36117-3507
Phone (334) 239-9480

Hospital & facility affiliations

Baptist Medical Center South Hospital · Montgomery, AL · CCN 010023

Medicare participation

Medicare fee-for-service enrollment: Enrolled in AL
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20171204000062	AL	Practitioner - Nurse Practitioner	4981747904	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Certified Registered Nurse, Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Ultracare Medical Services LLC		Current since Jan 5, 2010	Accepting new patients

Locations

215 Winton M Blount Loop
Montgomery, AL 36117
Phone (334) 239-9480

2257 Taylor Rd
Ste 200
Montgomery, AL 36117
Phone (334) 270-9914

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Gerontology Registered Nurse	163WG0600X	1-107325	AL	Yes

Addresses

Primary practice location

215 Winton M Blount Loop
Montgomery, AL 36117-3507

Mailing address

215 Winton M Blount Loop
Montgomery, AL 36117-3507
Phone (334) 239-9480

Other providers in Montgomery, AL

All providers in Montgomery, AL · Gerontology Registered Nurse in Alabama

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2017. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.