Verdure Exclusive PA
NPI 1295221711 · Internal Medicine Physician · Port Orange, FL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Verdure Exclusive PA is a Internal Medicine Physician organization in Port Orange, FL (NPI 1295221711).
Provider details
- NPI number
- 1295221711
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Tinuade Olusegun, Owner(386) 855-8633
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
3 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Angelic Lift
- Doing business as
- Angelic Lift
Additional practice locations (2)
- 12443 San Jose Blvd Ste 204Jacksonville, FL 32223-8648Phone: (386) 855-8633Fax: (855) 857-5810
- 12915 Jones Maltsberger Rd Ste 102San Antonio, TX 78247-4255Phone: (386) 855-8633Fax: (855) 857-5810
Registry dates
- Enumerated
- 2018-07-09
- Last updated
- 2022-12-13
- Certified
- 2022-12-13
Frequently asked questions
- What is Verdure Exclusive PA's NPI number?
- Verdure Exclusive PA's National Provider Identifier (NPI) is 1295221711, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Verdure Exclusive PA?
- Verdure Exclusive PA is classified in the NPPES registry as Internal Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Verdure Exclusive PA located?
- Verdure Exclusive PA's practice location on file with NPPES is 4645 Clyde Morris Blvd Ste 404, Port Orange, FL 32129-3005.
- What is Verdure Exclusive PA's phone number?
- The practice phone number listed in the NPPES registry for Verdure Exclusive PA is (386) 855-8633.
- Does Verdure Exclusive PA accept Medicare?
- Verdure Exclusive PA is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Verdure Exclusive PA?
- The authorized official listed on Verdure Exclusive PA's NPPES record is Tinuade Olusegun, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Verdure Exclusive PA's NPI active?
- Yes — Verdure Exclusive PA's NPI (1295221711) is active in the NPPES registry as of the last update on 2022-12-13.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.