Olatubosun Olasupo Oguntoye, M.D

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

01062399A Issued in IN

Practice address

1907 W Sycamore St
Kokomo, IN 46901-5148

Phone

(765) 236-8363

NPI assigned

Oct 11, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: olatubosun.oguntoye.1@7794.direct.athenahealth.com

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.

• St. Vincent Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • Winchester, IN
  • NPI 1144513375
  Medicare reassignment
• Joint Heirs Pediatrics LLC

  • Pediatrics Physician
  • Kokomo, IN
  • NPI 1164859880
  NPD (past)

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1891983243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 W SYCAMORE ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469015148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 W SYCAMORE ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469015148",
            "telephone_number": "765-236-8363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "419 E Lincoln Rd",
            "address_purpose": "LOCATION",
            "city": "Kokomo",
            "state": "IN",
            "postal_code": "469023716",
            "country_code": "US",
            "telephone_number": "765-864-2400",
            "fax_number": "765-864-2401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OGUNTOYE",
        "first_name": "OLATUBOSUN",
        "middle_name": "OLASUPO",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-11",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "19931",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01062399A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20091550",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA LICENSE",
            "identifier": "01062399A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric O'Banion, M.D.
• Baha Mohammed Taleb Obaidat, MBBS
• Veronica Ochoa, RBT
• Cheryl Oden, MA
• Calah Unique Oglesby
• Josephine Nkechi Okwechime, MD
• Trisha Oliba
• Clarisa D. Oliveira, DDS
• Matthew Nathaniel Isaac Oliver, PHD
• Cynthia Olson

• Pediatrics Physician in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.