Individual provider Active NPI

Olayemi Olusola Agbaje

  • Adult Health Nurse Practitioner
  • Orlando, FL
National Provider Identifier
1891395125
Registry record updated Oct 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN11009356 Issued in FL
Practice address
1012 Lucerne Ter
Orlando, FL 32806-1015
Phone
(407) 423-1039
Fax
(407) 425-2347
NPI assigned
Oct 27, 2020
Last updated
Oct 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11009356 FL
Adult Health Nurse Practitioner 363LA2200X APRN11009356 FL Primary

Addresses

Primary practice location

1012 Lucerne Ter
Orlando, FL 32806-1015

Mailing address

1012 Lucerne Ter
Orlando, FL 32806-1015
Phone (407) 423-1039

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211022001887 FL Practitioner - Nurse Practitioner 0244628303 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

1012 Lucerne Ter
Orlando, FL 32806-1015
Phone (407) 423-1039

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11009356FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc CurrentSince Oct 19, 2021 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Oct 19, 2021 Accepting new patients

Locations

1012 Lucerne Ter
Orlando, FL 32806
Phone (321) 841-7750

1414 Kuhl Ave
#38
Orlando, FL 32806
Phone (407) 481-7179

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: oagbaje165812@orlandohealth.medalliesdirect.net

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1891395125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 LUCERNE TER",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061015",
            "telephone_number": "407-423-1039",
            "fax_number": "407-425-2347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 LUCERNE TER",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061015",
            "telephone_number": "407-423-1039",
            "fax_number": "407-425-2347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGBAJE",
        "first_name": "OLAYEMI",
        "middle_name": "OLUSOLA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-27",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11009356",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11009356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.