Individual provider Active NPI

Olayinka Adetimehin

  • Family Nurse Practitioner
  • Buffalo, NY
National Provider Identifier
1407496730
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
356157 Issued in NY
Practice address
1021 Broadway St FL 3
Buffalo, NY 14212-1460
Phone
(716) 529-3020
NPI assigned
Jan 15, 2020
Last updated
Feb 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 698638 NY
Family Nurse Practitioner 363LF0000X 356157 NY Primary

Addresses

Primary practice location

1021 Broadway St FL 3
Buffalo, NY 14212-1460

Mailing address

184 Barton St
Buffalo, NY 14213-1573

Other practice location 1

184 Barton St
Buffalo, NY 14213-1573
Phone (716) 881-6191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20250324000192 NY Practitioner - Nurse Practitioner 3476075169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jericho Road Ministries, Inc.Group PAC ID 5597992933, 33 clinicians

Practice addresses (Care Compare)

1021 Broadway St
Buffalo, NY 14212-1460
Phone (716) 529-3020

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
698638NYMDRegistered Nurse
356157NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jericho Road Ministries Inc. CurrentSince Mar 1, 2025 Accepting new patients

Locations

1021 Broadway St
Buffalo, NY 14212
Phone (716) 529-3020

1021 Broadway St
Fl 3
Buffalo, NY 14212
Phone (716) 529-3020

184 Barton St
Buffalo, NY 14213
Phone (716) 348-3000

Interoperability endpoints

  • Direct secure messaging: olayinka.adetimehin@jrchc.medentdirect.com

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1407496730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 BARTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142131573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 BROADWAY ST FL 3",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142121460",
            "telephone_number": "716-529-3020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "184 Barton St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142131573",
            "country_code": "US",
            "telephone_number": "716-881-6191",
            "fax_number": "716-881-6247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADETIMEHIN",
        "first_name": "OLAYINKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-15",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "698638",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "356157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.