Individual provider Active NPI

Oluwaseyi Ayodeji Olasupo, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1033093786
Registry record updated Nov 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
SP033298 Issued in PA
Practice address
2144 Cecil B Moore Ave
Philadelphia, PA 19121-4014
Phone
(215) 320-6187
NPI assigned
Aug 5, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X SP033298 PA Primary

Addresses

Primary practice location

2144 Cecil B Moore Ave
Philadelphia, PA 19121-4014

Mailing address

2144 Cecil B Moore Ave
Philadelphia, PA 19121-4014
Phone (215) 320-6187

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260311000415 PA Practitioner - Nurse Practitioner 5496238156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1415 Fairmount Ave
Suite 241
Philadelphia, PA 19130-2962

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP033298PAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Project Home CurrentSince Jan 17, 2026 Accepting new patients
Project Home CurrentSince Jan 17, 2026 Accepting new patients

Locations

2144 Cecil B Moore Ave
Philadelphia, PA 19121
Phone (215) 320-6187

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HFBGDD/Endpoint/HFBGDD
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • FHIR API: https://fhir4.healow.com/fhir/r4/HFBGDD

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.

NPI Registry JSON

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

{
    "created_epoch": "1754352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764028800000",
    "number": "1033093786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2144 CECIL B MOORE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191214014",
            "telephone_number": "215-320-6187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2144 CECIL B MOORE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191214014",
            "telephone_number": "215-320-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLASUPO",
        "first_name": "OLUWASEYI",
        "middle_name": "AYODEJI",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-05",
        "last_updated": "2025-11-25",
        "certification_date": "2025-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP033298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.