Active NPI
Ebenezer Odunusi, M.D.
- Pediatrics Physician
- Lancaster, CA
National Provider Identifier
1891728663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A82385
- Practice address
- 44469 10TH St W
Lancaster, CA 93534-3324 - Phone
- (661) 945-9411
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A82385 | CA | Primary |
Addresses
Primary practice location
44469 10TH St W
Lancaster, CA 93534-3324
Mailing address
44469 10TH St W
Lancaster, CA 93534-3324
Phone (661) 945-9411
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HSP40248F | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A82385 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sierra Medical Group Holding Company, Inc. | Pediatrics | Past | Accepting new patients |
| Antelope Valley Health Care District | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- Lancaster, CA
- NPI 1366419517
-
- Multi-Specialty Clinic/Center
- Lancaster, CA
- NPI 1780832972
Pediatrics
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587427200000",
"number": "1891728663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44469 10TH ST W",
"city": "LANCASTER",
"state": "CA",
"postal_code": "935343324",
"telephone_number": "661-945-9411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44469 10TH ST W",
"city": "LANCASTER",
"state": "CA",
"postal_code": "935343324",
"telephone_number": "661-945-9411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODUNUSI",
"first_name": "EBENEZER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2020-04-21",
"certification_date": "2020-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A82385",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "HSP40248F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.