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OMOLOLA OTUBAGA NP
NPI 1033595566
Nurse Practitioner - Psychiatric/Mental Health in Fayetteville, GA

Active since August 06, 2015PECOS EnrolledAccepts Medicare Assignment
101 BECKETT LN, STE. 304, FAYETTEVILLE, GA 30214(770) 703-4448(770) 703-4038 Get Directions Write a Review

NPPES record last updated: April 25, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Omolola Otubaga Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

OMOLOLA OTUBAGA NP (NPI 1033595566) is an individual psychiatric/mental health provider in Fayetteville, Georgia, licensed in Georgia (RN207871) and active in the NPI registry since August 2015. She is enrolled in Medicare PECOS and is a graduate of Other (2015).

NPPES Registry Identity

NPI1033595566
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameOMOLOLA OTUBAGACredential: NP
Location Address101 BECKETT LN, STE. 304Fayetteville, GA 30214-7155
Mailing Address5465 Highway 42, 246Ellenwood, GA 30294-3928 · (470) 646-3738 · Fax (888) 910-6463
Phone(770) 703-4448
Fax(770) 703-4038
Sole ProprietorNo
Medical School CMSOtherGraduated 2015
Enumeration DateAugust 6, 2015
Last NPPES UpdateApril 25, 2023
NPPES CertifiedApril 25, 2023
✔ NPI 1033595566 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in GA · RN207871
101 BECKETT LN, Fayetteville, GA 30214
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Omolola Otubaga Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3779863188
PECOS Enrollment IDI20161130002356
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Omolola Otubaga reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mindset Healthcare, PC
2.7 mi
Psychiatric/Mental Health
135 BRADFORD SQ STE B
Fayetteville, GA 30215
  • Reassigned Medicare billing, Georgia enrollment
  • 4 clinicians in this Medicare group
NPI 1285119925 (470) 646-3738

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Psychotherapy with evaluation and management visit, 30 minutes 90833
Psychotherapy with evaluation and management is a 30-minute session where a mental health professional talks with you about your concerns and feelings. They assess your mental health, provide support, and manage your treatment plan to help improve your well-being.
61 services14 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
37 services13 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30214 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.06 typical visit price
range $56.84 – $172.43
Typical copayment $22.01 (range $14.21 – $43.10)
Most-billed visit code 99203
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SALIH O FALDON M.D.
Family Medicine
101 BECKETT LN, 506
FAYETTEVILLE, GA 30214
Fayette County (678) 817-9255
GOD'S IN CONTROL TRANSPORTATION SERVICES
Non-emergency Medical Transport (VAN)
101 BECKETT LN, SUITE 505
FAYETTEVILLE, GA 30214
Fayette County (404) 918-1926
PROVIDER RESOURCE SOLUTIONS LLC
Supports Brokerage
101 BECKETT LN
FAYETTEVILLE, GA 30214
Fayette County (404) 829-2715
ASHFORD DENTAL INC. II
Dentist (General Practice)
101 BECKETT LN, SUITE 403
FAYETTEVILLE, GA 30214
Fayette County (770) 461-0400
JENNIFER CORBITT FREEMAN, M.D., P.C.
Specialist
101 BECKETT LN, SUITE 506
FAYETTEVILLE, GA 30214
Fayette County (678) 817-6314
DR. ROBIN DWAYNE ASHFORD D.D.S.
Dentist
101 BECKETT LN, SUITE 404
FAYETTEVILLE, GA 30214
Fayette County (770) 461-0400
PROVIDER RESOURCE SOLUTIONS OF GEORGIA, INC
Community/Behavioral Health
101 BECKETT LN, SUITE 505
FAYETTEVILLE, GA 30214
Fayette County (404) 829-2715
AUGUSTA ABBEY
Non-emergency Medical Transport (VAN)
101 BECKETT LN, SUITE 505
FAYETTEVILLE, GA 30214
Fayette County (404) 918-1926

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Omolola Otubaga's NPI number?

The NPI number for Omolola Otubaga is 1033595566. It was assigned to this individual provider in the NPPES registry on August 6, 2015.

Where is Omolola Otubaga located?

Omolola Otubaga practices at 101 Beckett Ln Ste. 304, Fayetteville, GA 30214. The listed phone number is (770) 703-4448.

What is Omolola Otubaga's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Omolola Otubaga enrolled in Medicare?

Yes. Omolola Otubaga is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Omolola Otubaga's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Omolola Otubaga reassigns Medicare benefits to Mindset Healthcare, PC (Fayetteville, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Omolola Otubaga's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Omolola Otubaga was last updated on April 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.