Olusade O Fakolade

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71013601A Issued in IN

Practice address

833 Park East Blvd
Lafayette, IN 47905-0785

Phone

(765) 743-4400

NPI assigned

Feb 17, 2023

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

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sycamore Springs Physician Group LLCGroup PAC ID 2062634991, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Laby-K Mind Matters LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Indianapolis, IN
  • NPI 1801788872
  Medicare reassignment NPD Authorized official
• Sycamore Springs Physician Group LLC

  • Psychiatry Physician
  • Lafayette, IN
  • NPI 1972914539
  Medicare reassignment Care Compare group NPD
• Acute Behavioral Health Services, P.C.

  • Hospitalist Physician
  • Lafayette, IN
  • NPI 1700453388
  Medicare reassignment NPD

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

{
    "created_epoch": "1676592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1801594072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5477 RALFE RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462343753",
            "telephone_number": "317-457-7329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 PARK EAST BLVD",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479050785",
            "telephone_number": "765-743-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAKOLADE",
        "first_name": "OLUSADE",
        "middle_name": "O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-17",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71013601A",
            "primary": true
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "IN",
            "license": "71013601A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eyewear by Design, LLC
• Cydney Eylens
• Sylvia M Ezra, PHARMD
• Melanie Fackler
• Teresa Fairchild, RBT
• Giselle Falconi, MD
• Family Services, Inc.
• Anthony Fancher
• Fei Fang
• Deborah Jean Fansler, FNP-C, RN, MSN

• Psychiatric/Mental Health Nurse Practitioner in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; 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.
• Medicare Care Compare (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.