Active NPI
Olusola O. Sanusi-Agbabiaka, MD
- Emergency Medicine Physician
- Brooklyn, NY
National Provider Identifier
1417106477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 302725
- Practice address
- 451 Clarkson Ave
Brooklyn, NY 11203-2054 - Phone
- (718) 245-3131
- NPI assigned
- Sep 15, 2008
- Last updated
- Nov 24, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | NY | ||
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Emergency Medicine Physician | 207P00000X | 302725 | NY | Primary |
Addresses
Primary practice location
451 Clarkson Ave
Brooklyn, NY 11203-2054
Mailing address
451 Clarkson Ave
Brooklyn, NY 11203-2054
Phone (718) 245-3131
Other names 1
- Olusola O. Sanusi-Agbabiaka
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141014001293 | NY | Order and Referring Only - Physician Assistant | 1850512955 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302725 | NY | MD | Nurse Practitioner |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606176000000",
"number": "1417106477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "451 CLARKSON AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112032054",
"telephone_number": "718-245-3131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 CLARKSON AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112032054",
"telephone_number": "718-245-3131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANUSI-AGBABIAKA",
"first_name": "OLUSOLA",
"middle_name": "O.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-15",
"last_updated": "2020-11-24",
"certification_date": "2020-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NY",
"license": "302725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "OLUSOLA",
"last_name": "SANUSI-AGBABIAKA",
"middle_name": "O.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.