Bantale Oluremi Ayisire

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95033816 Issued in CA

Practice address

20623 Green Ash LN
Winnetka, CA 91306-1557

Phone

(253) 300-1864

Fax

(818) 303-3331

NPI assigned

Mar 13, 2025

Last updated

Mar 25, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Elty Minds & Research Solutions Group PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Winnetka, CA
  • NPI 1548130115
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1741824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774396800000",
    "number": "1538969282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20623 GREEN ASH LN",
            "city": "WINNETKA",
            "state": "CA",
            "postal_code": "913061557",
            "telephone_number": "253-300-1864",
            "fax_number": "818-303-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20623 GREEN ASH LN",
            "city": "WINNETKA",
            "state": "CA",
            "postal_code": "913061557",
            "telephone_number": "253-300-1864",
            "fax_number": "818-303-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYISIRE",
        "first_name": "BANTALE",
        "middle_name": "OLUREMI",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-03-13",
        "last_updated": "2026-03-25",
        "certification_date": "2026-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95033816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Athens Hospice,Inc.
• Athens Hospice,Inc.
• Aundreys Residential Care Inc.
• Aurora Garden Home Inc.
• Edmundo Jose Ayala-Orantes, DDS
• Humberto Jose Barboza, PA
• Rajni S Bawa, NP
• Bianca Liggayu Baylon, FNP
• Beauty for Ashes Maternal Wellness Inc.
• Bejoy House of Joy

• Psychiatric/Mental Health Nurse Practitioner in Winnetka, CA
• Providers in Winnetka, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.