Olasunbo Yetunde Ibrahim, APRN, FNP- BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN2296421 Issued in MA

Practice address

529 Main St Ste 222
Charlestown, MA 02129-1101

Phone

(617) 426-0600

NPI assigned

Jul 30, 2022

Last updated

Jan 6, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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 MA

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, 2022

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

Locations

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.

• Boston's Community Medical Group, Inc.

  dba CCA Primary Care

  • Primary Care Clinic/Center
  • Boston, MA
  • NPI 1235174418
  Medicare reassignment NPD
• Commonwealth Clinical Alliance, Inc

  • Case Manager/Care Coordinator
  • Boston, MA
  • NPI 1679605091
  Medicare reassignment NPD

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

{
    "created_epoch": "1659139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1598491540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 MAIN ST STE 222",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021291101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 MAIN ST STE 222",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021291101",
            "telephone_number": "617-426-0600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "940 Belmont St Bldg 4",
            "address_purpose": "LOCATION",
            "city": "Brockton",
            "state": "MA",
            "postal_code": "023015568",
            "country_code": "US",
            "telephone_number": "774-826-1842",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "OLASUNBO",
        "middle_name": "YETUNDE",
        "credential": "APRN, FNP- BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-30",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2296421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Howard, LMHC
• Isabel J Hughes
• Alexina Leora Hurley, CCC-SLP
• Kathryn Mary Hurley, PNP-PC
• KT Huskins
• Icare Therapy Ma LLC
• Aazeen Imran, MS, CCC-SLP
• Melissa Jacobo, LICSW, MAT
• David Reid Jacoby, M.D., PH.D.
• Jeffrey a Goldman,D.D.S,LLC

• Family Nurse Practitioner in Charlestown, MA
• Providers in Charlestown, MA by specialty
• Family Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; 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.