Tinuade Olusegun, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME137495 Issued in FL

Practice address

4645 Clyde Morris Blvd Ste 404
Port Orange, FL 32129-3005

Phone

(386) 855-8633

Fax

(855) 857-5810

NPI assigned

May 16, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Tinuade Olusegun-Gbadehan Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Verdure Exclusive PA

  • Internal Medicine Physician
  • Port Orange, FL
  • NPI 1295221711
  Medicare reassignment Authorized official
• National Primary Care Network, PA

  • Hospitalist Physician
  • Dallas, TX
  • NPI 1194748178
  NPD (past)

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670889600000",
    "number": "1760649917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4645 CLYDE MORRIS BLVD STE 404",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321293005",
            "telephone_number": "386-855-8633",
            "fax_number": "855-857-5810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 CLYDE MORRIS BLVD STE 404",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321293005",
            "telephone_number": "386-855-8633",
            "fax_number": "855-857-5810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12443 San Jose Blvd Ste 204",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322238648",
            "country_code": "US",
            "telephone_number": "386-855-8633",
            "fax_number": "855-857-5810",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12915 Jones Maltsberger Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782474255",
            "country_code": "US",
            "telephone_number": "386-855-8633",
            "fax_number": "855-857-5810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLUSEGUN",
        "first_name": "TINUADE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-16",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N3663",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME137495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINUADE",
            "last_name": "OLUSEGUN-GBADEHAN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Options Home Health of North Florida, Inc.

• Internal Medicine Physician in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.