Individual provider Active NPI

Olagoke Osanyinlusi

  • Family Medicine Physician
  • Grandview, MO
National Provider Identifier
1902787138
Registry record updated Sep 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2025032312 Issued in MO
Practice address
13013 Fuller Ave Ste a
Grandview, MO 64030-2687
Phone
(816) 214-5548
NPI assigned
Sep 12, 2025
Last updated
Sep 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2025032312 MO Primary

Addresses

Primary practice location

13013 Fuller Ave Ste a
Grandview, MO 64030-2687

Mailing address

4431 Chouteau Ave Apt 1109
Saint Louis, MO 63110-1607
Phone (314) 356-0519

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2025032312MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medina Clinic, Incorporated PastSince Sep 14, 2025 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1757635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1902787138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4431 CHOUTEAU AVE APT 1109",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101607",
            "telephone_number": "314-356-0519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13013 FULLER AVE STE A",
            "city": "GRANDVIEW",
            "state": "MO",
            "postal_code": "640302687",
            "telephone_number": "816-214-5548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSANYINLUSI",
        "first_name": "OLAGOKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-12",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2025032312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grandview, MO

Sources for this page

Verify at the official NPI Registry.