NPIMap

Organization Active NPI

Osup Community Outreach LLC

  • Neurology Physician
  • Dublin, OH
National Provider Identifier
1699179929
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
OSUP COMMUNITY OUTREACH LLC
Practice address
555 Metro PL N
Dublin, OH 43017-5362
Phone
(614) 410-9580
Fax
(614) 844-4589
NPI assigned
Oct 15, 2014
Last updated
Jan 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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

Authorized official

Name
Mr. Kyle L. Sharp
Title
Associate Executive Director
Phone
(614) 293-3202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X Primary

Addresses

Primary practice location

555 Metro PL N
Dublin, OH 43017-5362

Mailing address

700 Ackerman Rd Ste 2120
Columbus, OH 43202-1559
Phone (614) 685-4601

Other identifiers 2

IdentifierTypeStateIssuer
0112258MedicaidOH
DV2507OtherOHRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, FL, NC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20141217001070 OH Part B Supplier - Clinic/Group Practice 5799008082 Receives reassigned benefits from 211 practitioners
Practice locations: Dublin, OH; Westerville, OH; Washington Court House, OH; Rootstown, OH; Logan, OH; Hillsboro, OH; Hilliard, OH; Gahanna, OH…
O20250725003165 FL Part B Supplier - Clinic/Group Practice 5799008082 Receives reassigned benefits from 3 practitioners
Practice locations: Indian Shores, FL; Melbourne, FL
O20251019000040 NC Part B Supplier - Clinic/Group Practice 5799008082 Receives reassigned benefits from 1 practitioner
Practice locations: Fayetteville, NC

National Provider Directory

National Provider Directory

Locations

5109 W Broad St
Columbus, OH 43228
Phone (614) 544-1976

4995 Bradenton Ave
Dublin, OH 43017
Phone (614) 580-6917

555 Metro Pl N
Dublin, OH 43017
Phone (614) 410-9580

4211 State Route 44
Ste 203
Rootstown, OH 44272
Phone (330) 325-3202

Practitioners & affiliated clinicians

Practitioners 221

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 221

NPI Registry JSON

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

{
    "created_epoch": "1413331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674691200000",
    "number": "1699179929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 ACKERMAN RD STE 2120",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432021559",
            "telephone_number": "614-685-4601",
            "fax_number": "614-366-3731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 METRO PL N",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430175362",
            "telephone_number": "614-410-9580",
            "fax_number": "614-844-4589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSUP COMMUNITY OUTREACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-15",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "SHARP",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "ASSOCIATE EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "614-293-3202",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0112258",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DV2507",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dublin, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.