Fatima Agha, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Brooksville, FL
NPI 1912437286 · NPPES record last updated Jun 19, 2017
Key facts
- NPI
- 1912437286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- License
- TRN24258 (FL)
- Practice address
- 11375 Cortez Blvd
Brooksville, FL 34613-5409 - Phone
- (352) 592-2753
- Fax
- (352) 592-2753
- NPI assigned
- Jun 19, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Atlanticare Physician Group PA
Practice addresses (Care Compare)
1925 Pacific Ave
Atlantic City, NJ 08401-6713
Phone (609) 441-8146
Hospital & facility affiliations
- Atlanticare Regional Medical Center - City Campus
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200922000003 | NJ | Practitioner - Internal Medicine | 2264850379 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TRN24258 | FL | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlanticare Physician Group PA | Current |
Accepting new patients | |
| Atlanticare Regional Medical Center | Current |
Accepting new patients | |
| Atlanticare Physician Group, PA | Current |
Accepting new patients | |
| Atlanticare Regional Medical Center | Current |
Accepting new patients | |
| Atlanticare Regional Medical Center | Past | Accepting new patients |
Locations
1925 Pacific Ave
Atlantic City, NJ 08401
Phone (609) 441-8023
459 Route 9 S
Little Egg Harbor Twp, NJ 08087
Phone (609) 340-7815
65 W Jimmie Leeds Rd
Pomona, NJ 08240
Phone (609) 484-6414
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | TRN24258 | FL | Yes |
Addresses
Primary practice location
11375 Cortez Blvd
Brooksville, FL 34613-5409
Mailing address
11375 Cortez Blvd
Brooksville, FL 34613-5409
Phone (352) 579-2753
Other providers in Brooksville, FL
- Advanced Pediatric Center LLC
- Advanced Podiatry, PA
- Advanced Practitioners
- Adventhealth Home Health and Hospice Inc
- Kainat Aftab
- Kunal Agrawal
- Iffath Muneer Ahmed
- Sagheer Rauf Ahmed
- Natalya Ahsan
- Martha Lyn Aiello
All providers in Brooksville, FL · Student in an Organized Health Care Education/Training Program in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 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.