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 18 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 Enrolled

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: October 25, 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 and maintains a secondary practice location in Brooklyn.

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

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, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Olutayo Olaide Olasupo Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Olutayo Olasupo reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Multiviz Medical Services PC

Same address

Internal Medicine

529 BEACH 20TH ST
Far Rockaway, NY 11691

Reassigned Medicare billing, New York enrollment
49 clinicians in this Medicare group

NPI 1720373293 (718) 327-7307

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 enrollment system.

Which organization bills Medicare for Olutayo Olasupo's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Olutayo Olasupo reassigns Medicare benefits to Multiviz Medical Services PC (Far Rockaway, NY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Olutayo Olasupo's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

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 18 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.