Individual provider Active NPI

Fatima Agha, MD

  • Student in an Organized Health Care Education/Training Program
  • Brooksville, FL
National Provider Identifier
1912437286
Registry record updated Jun 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
TRN24258 Issued in FL
Practice address
11375 Cortez Blvd
Brooksville, FL 34613-5409
Phone
(352) 592-2753
Fax
(352) 592-2753
NPI assigned
Jun 19, 2017
Last updated
Jun 19, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X TRN24258 FL Primary

Addresses

Primary practice location

11375 Cortez Blvd
Brooksville, FL 34613-5409

Mailing address

11375 Cortez Blvd
Brooksville, FL 34613-5409
Phone (352) 579-2753

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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

Enrollment IDStateProvider typePAC IDDetails
I20200922000003 NJ Practitioner - Internal Medicine 2264850379 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlanticare Physician Group PAGroup PAC ID 8527953660, 506 clinicians

Practice addresses (Care Compare)

1925 Pacific Ave
Atlantic City, NJ 08401-6713
Phone (609) 441-8146

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TRN24258FLMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanticare Physician Group, PA CurrentSince Sep 27, 2020 Accepting new patients
Atlanticare Physician Group PA CurrentSince Sep 27, 2020 Accepting new patients
Atlanticare Regional Medical Center CurrentSince Aug 15, 2025 Accepting new patients
Atlanticare Regional Medical Center CurrentSince Aug 15, 2025 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

Organizations & group practices 5

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 1

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": "1497830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497830400000",
    "number": "1912437286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11375 CORTEZ BLVD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346135409",
            "telephone_number": "352-579-2753",
            "fax_number": "352-591-6317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11375 CORTEZ BLVD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346135409",
            "telephone_number": "352-592-2753",
            "fax_number": "352-592-2753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGHA",
        "first_name": "FATIMA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-19",
        "last_updated": "2017-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "TRN24258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooksville, FL

Sources for this page

Verify at the official NPI Registry.