FAKAYATU IBIRONKE AGBOOLA — NPI 1306572821 (Licensed & Credentialed Registered Nurse in LAWRENCEVILLE, GA)

CMS-1500 Box 24J / 33a • NPI

1306572821

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

163W00000X

Licensed & Credentialed Registered Nurse

Box 32 Service Location & ZIP+4

175 GWINNETT DR, LAWRENCEVILLE, GA, 30046-8444

✓ 9-Digit EDI 837 ZIP+4 (30046-8444)

Practice Phone & Referral Fax

(678) 209-2396

Direct NPPES Verification Line

⚠️ HHS OIG LEIE FEDERAL EXCLUSION ALERT: NPI 1306572821 matches an active entry in the HHS Office of Inspector General List of Excluded Individuals/Entities (Sec. 1128(b)(4) — License Revocation, Suspension, or Surrender — Effective 2024-01-18). Verify before submitting Medicare/Medicaid claims.

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1306572821` (NPI-1 Individual Practitioner)
Provider / Legal Name	FAKAYATU IBIRONKE AGBOOLA
Plain-English Specialty	Licensed & Credentialed Registered Nurse NUCC Code: `163W00000X` (Registered Nurse)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	175 GWINNETT DR, LAWRENCEVILLE, GA, 30046-8444
Practice Telephone / Fax	Tel: (678) 209-2396
Administrative Mailing Address	2209 SWAN LAKE CT, GRAYSON, GA, 30017-4222
Enumeration & Last Sync	Enumerated: 2022-07-27 \| CMS Record Updated: 2022-07-27

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

175 GWINNETT DR, LAWRENCEVILLE, GA, 30046-8444

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Plain-English Taxonomy & CMS Crosswalk (163W00000X)

What Does Taxonomy Code 163W00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 163W00000X translates to:
"Licensed & Credentialed Registered Nurse"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Registered Nurse for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (FAKAYATU IBIRONKE AGBOOLA)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`163W00000X` — Registered Nurse Plain English: Licensed & Credentialed Registered Nurse	State: MO \| License: `2021007170` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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FAKAYATU IBIRONKE AGBOOLA (NPI #1306572821)