Organization Active NPI

O.B. Adult Health Nurse Practitioner Services PC

  • Clinic/Center
  • Staten Island, NY
National Provider Identifier
1164933487
Registry record updated Nov 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
F307489 Issued in NY
Legal business name
O.B. ADULT HEALTH NURSE PRACTITIONER SERVICES PC
Practice address
209 Broad St
Staten Island, NY 10304-2105
Phone
(917) 374-9180
Fax
(718) 448-7263
NPI assigned
Oct 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2018

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

Authorized official

Name
Olasunkanmi Bhadmus, NURSE PRACTITIONERNPI 1417263328
Title
Assistant Director
Phone
(917) 374-9180

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X F307489 NY Primary
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X F307489 NY
Gerontology Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SG0600X 573342 NY

Addresses

Primary practice location

209 Broad St
Staten Island, NY 10304-2105

Mailing address

224 Osgood Ave
Staten Island, NY 10304-3607

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181115001174 NY Part B Supplier - Clinic/Group Practice 4880948553 Receives reassigned benefits from 5 practitioners
Practice locations: Staten Island, NY

National Provider Directory

National Provider Directory

Locations

979 Bay St
Ste 3
Staten Island, NY 10305
Phone (917) 830-1838

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541116800000",
    "number": "1164933487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 OSGOOD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103043607",
            "fax_number": "718-448-7263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 BROAD ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103042105",
            "telephone_number": "917-374-9180",
            "fax_number": "718-448-7263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "O.B. ADULT HEALTH NURSE PRACTITIONER SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-13",
        "last_updated": "2018-11-02",
        "status": "A",
        "authorized_official_last_name": "BHADMUS",
        "authorized_official_first_name": "OLASUNKANMI",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR",
        "authorized_official_telephone_number": "917-374-9180",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": "F307489",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F307489",
            "primary": false
        },
        {
            "code": "364SG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "NY",
            "license": "573342",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.