Individual provider Active NPI

Ibukun Ayodeji Sonaike, MD

  • Pediatric Critical Care Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1467972687
Registry record updated Mar 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
74172 Issued in MN
Practice address
701 Park Ave
Minneapolis, MN 55415-1623
Phone
(612) 873-3000
NPI assigned
Jun 20, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 61030795 WA
Pediatric Critical Care Medicine Physician 2080P0203X 74172 MN Primary

Addresses

Primary practice location

701 Park Ave
Minneapolis, MN 55415-1623

Mailing address

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230602001146 MN Practitioner - Pediatric MedicinePractitioner - Critical Care (Intensivists) 4880024249 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61030795WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin Healthcare System Inc CurrentSince Jul 1, 2023 Accepting new patients
Hennepin Healthcare System, Inc Current Accepting new patients
Hennepin Healthcare System, Inc CurrentSince Jul 1, 2023 Accepting new patients
Hennepin Healthcare System, Inc Past Accepting new patients

Locations

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

Organizations & group practices 4

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": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711670400000",
    "number": "1467972687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONAIKE",
        "first_name": "IBUKUN",
        "middle_name": "AYODEJI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-20",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "61030795",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MN",
            "license": "74172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.