Individual provider Active NPI

Olatunde Kuponiyi, DO

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1003549205
Registry record updated Jul 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS024086 Issued in PA
Practice address
900 Walnut St
Philadelphia, PA 19107-5191
Phone
(215) 955-7000
NPI assigned
Jul 5, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS024086 PA Primary

Addresses

Primary practice location

900 Walnut St
Philadelphia, PA 19107-5191

Mailing address

901 Walnut St
Philadelphia, PA 19107-5214
Phone (215) 955-7000

Other practice location 1

111 S 11th St
Philadelphia, PA 19107-4870
Phone (215) 955-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250718000253 PA Practitioner - Internal Medicine 4587170568 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rowan University School of Osteopathic Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

111 S 11TH St
Philadelphia, PA 19107-4824
Phone (215) 955-6540

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS024086PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Internal Medicine CurrentSince Jul 1, 2025 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

900 Walnut St
Philadelphia, PA 19107
Phone (215) 503-8080

111 S 11th St
Philadelphia, PA 19107
Phone (215) 955-6161

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1656979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1003549205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 WALNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075214",
            "telephone_number": "215-955-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 WALNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075191",
            "telephone_number": "215-955-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 S 11th St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191074870",
            "country_code": "US",
            "telephone_number": "215-955-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUPONIYI",
        "first_name": "OLATUNDE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-05",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS024086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.