Ilako Chrystelle Agbatchi-Houedan, NP
Individual provider Active NPI Nurse Practitioner · Augusta, GA
NPI 1922693134 · NPPES record last updated Jan 10, 2023
Key facts
- NPI
- 1922693134
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- RN279629 (GA)
- Practice address
- 1120 15TH St
Augusta, GA 30912-0004 - Phone
- (706) 721-8623
- Fax
- (706) 721-1459
- NPI assigned
- Mar 9, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Pallicare, Inc
Practice addresses (Care Compare)
5803 Stoneridge Dr
Texarkana, TX 75503-1461
Phone (903) 278-5747
Hospital & facility affiliations
- Pathfinder Home Health
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.93 of 100
- Quality
- 82.14
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210520000846 | GA | Practitioner - Nurse Practitioner | 7113326323 | Reassigns benefits to 1 organization |
| I20250910003625 | TX | Practitioner - Nurse Practitioner | 7113326323 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN279629 | GA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Au Medical Associates Inc | Current |
Accepting new patients | |
| Rippl Care PC of Washington Inc | Current |
Accepting new patients | |
| Au Medical Associates Inc | Current |
Accepting new patients | |
| Pallicare, Inc | Current |
Accepting new patients | |
| Rippl Care PC of New Jersey, PC | Past | Accepting new patients |
Locations
1120 15th St
Augusta, GA 30912
Phone (706) 721-3873
1120 15th St
Ste BI1056
Augusta, GA 30912
Phone (706) 721-2785
1120 15th St
#6000
Augusta, GA 30912
Phone (706) 721-3813
40 NE Loop 410
Ste 100
San Antonio, TX 78216
Phone (714) 717-5744
13423 Blanco Rd
San Antonio, TX 78216
2825 Eastlake Ave E
Seattle, WA 98102
Interoperability endpoints
- ilako.agbatchi-houedan.1@29558.direct.athenahealth.com
- ilako.agbatchi-houedan.1@26850.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN279629 | GA | Yes |
Addresses
Primary practice location
1120 15TH St
Augusta, GA 30912-0004
Mailing address
1120 15TH St
Or 6000
Augusta, GA 30912-0004
Phone (706) 721-3813
Other providers in Augusta, GA
- Zachary Scott Agan
- Agape Day Living LLC
- Agape Living LLC
- Agape Living LLC
- Gautam Agarwal
- Obiora Agbimson
- Ishan Aggarwal
- Soheila Aghdasi
- Aging Care Providers LLC
- Mouchammed Agko
All providers in Augusta, GA · Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2023. 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.