DR. OLUTAYO OLAIDE OLASUPO MD
NPI 1114713054
Internal Medicine in Far Rockaway, NY

Q: What is Olutayo Olasupo's NPI number?

The NPI number for Olutayo Olasupo is 1114713054. It was assigned to this individual provider in the NPPES registry on April 17, 2025.

Q: What is Olutayo Olasupo's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Q: When was this NPI record last updated?

The NPPES record for Olutayo Olasupo was last updated on April 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 17, 2025PECOS EnrolledAccepts Medicare Assignment

529 BEACH 20TH ST, FAR ROCKAWAY, NY 11691(718) 327-7307(718) 327-3294 Get Directions Write a Review

NPPES record last updated: April 17, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Olutayo Olaide Olasupo Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. OLUTAYO OLAIDE OLASUPO MD (NPI 1114713054) is an individual internal medicine provider in Far Rockaway, New York, licensed in New York (P128167) and active in the NPI registry since April 2025. He is enrolled in Medicare PECOS, maintains a secondary practice location in Brooklyn, and is a graduate of Other (2006).

NPPES Registry Identity

NPI1114713054

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameDR. OLUTAYO OLAIDE OLASUPOCredential: MD

Location Address529 BEACH 20TH STFar Rockaway, NY 11691-3615

Mailing Address529 Beach 20th StFar Rockaway, NY 11691-3615 · (718) 327-7307 · Fax (718) 327-3294

Phone(718) 327-7307

Fax(718) 327-3294

Sole ProprietorYes

Medical School CMSOtherGraduated 2006

Enumeration DateApril 17, 2025

NPPES CertifiedApril 12, 2025

✔ NPI 1114713054 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in NY · P128167

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

529 BEACH 20TH ST, Far Rockaway, NY 11691

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Secondary Practice Location 1

Location 1140 Saint Edwards StBrooklyn, NY 11201-3904 · Phone (718) 858-6400

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Olutayo Olaide Olasupo Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9133644057

PECOS Enrollment IDI20250423000931

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11691 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$153.13 typical visit price

range $67.00 – $201.98

Typical copayment $38.28 (range $16.75 – $50.49)

Most-billed visit code 99204

Established Patient

$116.96 typical visit price

range $21.62 – $163.52

Typical copayment $29.24 (range $5.40 – $40.88)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STELLA POLVANOVA N.P.

Nurse Practitioner (Adult Health)

529 BEACH 20TH ST
FAR ROCKAWAY, NY 11691

Queens County (718) 327-7307

DR. ALBERT BARAVARIAN M.D.

Internal Medicine

529 BEACH 20TH ST
FAR ROCKAWAY, NY 11691

Queens County (718) 327-7307

DR. YOLANDE FRANCES BERNARD M.D.

Internal Medicine

529 BEACH 20TH ST
FAR ROCKAWAY, NY 11691

Queens County (718) 327-7307

CHRISTOPHER EMOVON

Internal Medicine

529 BEACH 20TH ST
FAR ROCKAWAY, NY 11691

Queens County (718) 327-7307

ROCKAWAY HD LLC

Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)

529 BEACH 20TH ST, 1ST FLOOR
FAR ROCKAWAY, NY 11691

Queens County (718) 327-7307

OLUSEGUN OGUNFOWORA MD

Internal Medicine

529 BEACH 20TH ST
FAR ROCKAWAY, NY 11691

Queens County (718) 327-7307

POLINA KHANINA MD

Internal Medicine

529 BEACH 20TH ST
FAR ROCKAWAY, NY 11691

Queens County (718) 327-7307

ABIOLA FAMILUSI

Internal Medicine

529 BEACH 20TH ST
FAR ROCKAWAY, NY 11691

Queens County (718) 327-7307

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Olutayo Olasupo's NPI number?

The NPI number for Olutayo Olasupo is 1114713054. It was assigned to this individual provider in the NPPES registry on April 17, 2025.

Where is Olutayo Olasupo located?

Olutayo Olasupo practices at 529 Beach 20th St, Far Rockaway, NY 11691. The listed phone number is (718) 327-7307.

What is Olutayo Olasupo's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Olutayo Olasupo enrolled in Medicare?

Yes. Olutayo Olasupo is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Olutayo Olasupo was last updated on April 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.