1. Home
  2. Directory
  3. Florida
  4. Port Orange
  5. Internal Medicine
  6. NPI Profile

TINUADE OLUSEGUN M.D.
NPI 1760649917
Internal Medicine in Port Orange, FL

Active since May 16, 2008PECOS Enrolled
4645 CLYDE MORRIS BLVD STE 404, PORT ORANGE, FL 32129(386) 855-8633(855) 857-5810 Get Directions Write a Review

NPPES record last updated: December 13, 2022. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Dec 13, 2022, Aug 5, 2020, Aug 19, 2019 and 5 more (8 updates tracked since 2016).

About Tinuade Olusegun M.d. NPPES

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

TINUADE OLUSEGUN M.D. (NPI 1760649917) is an individual internal medicine provider in Port Orange, Florida, licensed in Florida (ME137495) and active in the NPI registry since May 2008. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1760649917
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameTINUADE OLUSEGUNCredential: M.D.
Location Address4645 CLYDE MORRIS BLVD STE 404Port Orange, FL 32129-3005
Mailing Address4645 Clyde Morris Blvd Ste 404Port Orange, FL 32129-3005 · (386) 855-8633 · Fax (855) 857-5810
Phone(386) 855-8633
Fax(855) 857-5810
Sole ProprietorNo
Enumeration DateMay 16, 2008
Last NPPES UpdateDecember 13, 20228 updates tracked since enumeration
NPPES CertifiedDecember 13, 2022
✔ NPI 1760649917 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Licenses✔ Licensed in FL · ME137495✔ Licensed in TX · N3663
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
4645 CLYDE MORRIS BLVD STE 404, Port Orange, FL 32129
Open in Google Maps ↗

Other Names 1

Former Name (1)Tinuade Olusegun-gbadehan Md

Secondary Practice Locations 2

Location 112443 San Jose Blvd Ste 204Jacksonville, FL 32223-8648 · Phone (386) 855-8633 · Fax (855) 857-5810
Location 212915 Jones Maltsberger Rd Ste 102San Antonio, TX 78247-4255 · Phone (386) 855-8633 · Fax (855) 857-5810

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tinuade Olusegun M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Tinuade Olusegun reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Verdure Exclusive PA
Same address
Internal Medicine
4645 CLYDE MORRIS BLVD STE 404
Port Orange, FL 32129
  • Reassigned Medicare billing, Florida enrollment
NPI 1295221711 (386) 855-8633

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32129 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
$130.04 typical visit price
range $56.00 – $171.84
Typical copayment $32.51 (range $14.00 – $42.96)
Most-billed visit code 99204
Established Patient
$99.16 typical visit price
range $17.57 – $139.16
Typical copayment $24.79 (range $4.39 – $34.79)
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 2

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

TAYLER PRICE
Nurse Practitioner (Family)
4645 CLYDE MORRIS BLVD STE 404
PORT ORANGE, FL 32129
Volusia County (386) 855-8633
VERDURE EXCLUSIVE PA
Internal Medicine
4645 CLYDE MORRIS BLVD STE 404
PORT ORANGE, FL 32129
Volusia County (386) 855-8633

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 Tinuade Olusegun's NPI number?

The NPI number for Tinuade Olusegun is 1760649917. It was assigned to this individual provider in the NPPES registry on May 16, 2008. The provider is also known as Tinuade Olusegun-Gbadehan MD.

Where is Tinuade Olusegun located?

Tinuade Olusegun practices at 4645 Clyde Morris Blvd Ste 404, Port Orange, FL 32129. The listed phone number is (386) 855-8633.

What is Tinuade Olusegun's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Tinuade Olusegun enrolled in Medicare?

Yes. Tinuade Olusegun is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Tinuade Olusegun's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tinuade Olusegun reassigns Medicare benefits to Verdure Exclusive PA (Port Orange, FL). 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 Tinuade Olusegun'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 Tinuade Olusegun was last updated on December 13, 2022. 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.