Olubusola Temidayo Daramola

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

824556 Issued in TX

Practice address

206 Walls Dr
Cleburne, TX 76033-4045

Phone

(817) 645-0668

Fax

(817) 645-0720

NPI assigned

Sep 3, 2012

Last updated

Jun 2, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in TX

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, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Agape Internal Medicine PCGroup PAC ID 5991958860, 2 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Agape Internal Medicine, PC

  • Specialist
  • Fort Worth, TX
  • NPI 1376896845
  Medicare reassignment Care Compare group NPD
• Zen House LLC

  • Adult Companion
  • Fort Worth, TX
  • NPI 1891587911
  NPD Authorized official

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

{
    "created_epoch": "1346630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370131200000",
    "number": "1871842161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6080 S HULEN ST",
            "address_2": "SUITE 360 PMB 229",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761322622",
            "telephone_number": "864-426-2306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 WALLS DR",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760334045",
            "telephone_number": "817-645-0668",
            "fax_number": "817-645-0720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DARAMOLA",
        "first_name": "OLUBUSOLA",
        "middle_name": "TEMIDAYO",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-03",
        "last_updated": "2013-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "824556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP",
            "identifier": "DO7564",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PTAN",
            "identifier": "P01111340",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2035487-04",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3089625-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PTAN",
            "identifier": "890N47",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dang Medical Clinic PA
• Danhjohn Tai Dang, MD
• Herbert Bruce Daniels III, MD
• Sean Daniels
• John Bamidele Daramola, MD
• Fidel Davila
• Janice Marie Davila, RD, LD
• Joe Russell Davis, RPH
• Lynne A Davis, PT
• Sidney Charles Davis, D.D.S.

• Family Nurse Practitioner in Cleburne, TX
• Providers in Cleburne, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2013; 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.