Modupe Fadojutimi, NURSE PRACTITIONER

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

R194540 Issued in MD

Practice address

1 Magnolia Dr
La Plata, MD 20646-9357

Phone

(301) 934-4001

NPI assigned

Mar 13, 2019

Last updated

Mar 13, 2019By 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

Medicare fee-for-service enrollment

Enrolled in MD, DC, VA3 enrollments

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 3

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Villagehealth DM LLCGroup PAC ID 2769812445, 161 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Villagehealth DM LLC

  • Case Management Agency
  • Denver, CO
  • NPI 1598273211

  MD

  Medicare reassignment Care Compare group
• PA Post Acute Services PC

  • General Practice Physician
  • Masury, OH
  • NPI 1255057063

  VA

  Medicare reassignment NPD

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

{
    "created_epoch": "1552435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552435200000",
    "number": "1952860660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MAGNOLIA DR",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206469357",
            "telephone_number": "301-934-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MAGNOLIA DR",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206469357",
            "telephone_number": "301-934-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADOJUTIMI",
        "first_name": "MODUPE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-13",
        "last_updated": "2019-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MD",
            "license": "R194540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Daniel Evans, CF-SLP
• Michelle Evans, LCPC, LPC
• Expanding Horizons Counseling and Wellness
• Express Mobile Lab
• Uchechukwu Janet Eyisi, PHARMD
• Family Focus Therapy and Education Services, LLC. (Family Focus Therapy)
• Family Orthodontics of Maryland LLC
• Maria Zsallerdie Fernandez, BSN, RN
• Laurier Ferraioli, M.S, CCC-SLP
• Gregg A Ferrero, M.D.

• Primary Care Nurse Practitioner in La Plata, MD
• Providers in La Plata, MD by specialty
• Primary Care Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; 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.