Olatubosun Odusi, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

216736 Issued in NY

Practice address

3707 Doty Rd Ste H
Woodstock, IL 60098-7530

Phone

(815) 206-2800

Fax

(815) 337-5491

NPI assigned

Sep 14, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 14

Medicare fee-for-service enrollment

Enrolled in NY, IL2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: olatubosunodusi@mai.allscriptsdirect.net
• Direct secure messaging: olatubosun.odusi.p1@direct.mmc.nextgenshare.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.

• Central Dupage Physician Group

  • Family Medicine Physician
  • Carol Stream, IL
  • NPI 1033149844

  IL, Pediatrics

  Medicare reassignment NPD
• Maimonides Faculty Practice Plan

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1053344846

  NY

  Medicare reassignment NPD
• MMC Pediatrics Faculty Practice

  • Pediatrics Physician
  • Brooklyn, NY
  • NPI 1285648154

  NY, Pediatrics

  Medicare reassignment NPD
• Central Dupage Physician Group

  • Orthopaedic Surgery Physician
  • Geneva, IL
  • NPI 1780012344
  NPD
• Maimonides Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1093777492
  NPD

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1972598084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 DOTY RD STE H",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600987530",
            "telephone_number": "815-206-2800",
            "fax_number": "815-337-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3707 DOTY RD STE H",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600987530",
            "telephone_number": "815-206-2800",
            "fax_number": "815-337-5491"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4802 10th Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112192844",
            "country_code": "US",
            "telephone_number": "718-283-7500",
            "fax_number": "718-635-7235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODUSI",
        "first_name": "OLATUBOSUN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "216736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AFFINITY HEALTH",
            "identifier": "1000006625",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLAN",
            "identifier": "P2164401",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "216736",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "2C9466",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2031247",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "7440270",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA USHC PPO",
            "identifier": "2592835",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "2697890",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATLANTIS HEALTH PLAN",
            "identifier": "OO6736",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02112912",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS",
            "identifier": "112940201",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "0100713-02",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BCBS",
            "identifier": "1R0921",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH FIRST",
            "identifier": "216736-A15",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Colleen O'Leary
• Oakford Physical Therapy Inc
• Mary Margaret Oakford, PT
• Randhirji Odedra, M.D.
• Tracey Ann Odishoo, C.N.P.
• Bolatito Olubukola Ogunsanwo, APRN, CNP
• Kasey Olson, MSW
• Orthomidwest, PLLC
• Maria Guadalupe Ortiz-Carbajal
• Ossip Management Solutions, LLC

• Pediatrics Physician in Woodstock, IL
• Providers in Woodstock, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; 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.