NPIMap

Individual provider Active NPI

Osaretin B Idusuyi, MD

  • Orthopaedic Foot and Ankle Surgery Physician
  • Quincy, IL
National Provider Identifier
1417944091
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Foot and Ankle Surgery PhysicianTaxonomy code 207XX0004X
License
036095609 Issued in IL
Practice address
1118 Hampshire St
Quincy, IL 62301-3027
Phone
(217) 222-6550
Fax
(217) 277-2253
NPI assigned
Sep 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 036095609 IL
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X 036095609 IL Primary

Addresses

Primary practice location

1118 Hampshire St
Quincy, IL 62301-3027

Mailing address

1118 Hampshire St
Quincy, IL 62301-3027
Phone (217) 222-6550

Other identifiers 1

IdentifierTypeStateIssuer
036095609MedicaidIL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100123000186 IL Practitioner - Orthopedic Surgery 2769524180 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Meharry Medical College School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1118 Hampshire St
Quincy, IL 62301-3027
Phone (217) 222-6550

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
63.56 of 100Reported as group
Quality
57.12
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue32
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036095609ILMDOrthopaedic Foot and Ankle Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Sep 3, 2024 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Nov 1, 1997 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Nov 1, 1997 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Sep 3, 2024 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC Current Accepting new patients
Orthopaedic Center of Illinois Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

1215 Franciscan Dr
Litchfield, IL 62056
Phone (217) 324-2191

1118 Hampshire St
Quincy, IL 62301

1025 Maine St
Quincy, IL 62301
Phone 21722265503163

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

Interoperability endpoints

  • Direct secure messaging: obi001@oci2123.srs-direct.com
  • Direct secure messaging: oidusuyi1103548@direct.unitypoint.org

Organizations & group practices 8

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": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1417944091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 HAMPSHIRE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623013027",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 HAMPSHIRE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623013027",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDUSUYI",
        "first_name": "OSARETIN",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "036095609",
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "IL",
            "license": "036095609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036095609",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, IL

Sources for this page

Verify at the official NPI Registry.