Individual provider Active NPI

Lynda Ikeogu, RN

  • Psychiatric/Mental Health Nurse Practitioner
  • Randolph, MA
National Provider Identifier
1043073539
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN271418 Issued in MA
Practice address
16 Lancaster Rd
Randolph, MA 02368-4942
Phone
(781) 300-1495
Fax
(781) 767-5939
NPI assigned
Feb 6, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 271418 MA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN271418 MA Primary

Addresses

Primary practice location

16 Lancaster Rd
Randolph, MA 02368-4942

Mailing address

16 Lancaster Rd
Randolph, MA 02368-4942
Phone (781) 300-1495

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250409001724 MA Practitioner - Nurse Practitioner 3577087766 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Brockton Area Multi-Services, Inc. CurrentSince Feb 22, 2025 Accepting new patients
Supportive Behavioral Care of Ma LLC CurrentSince Apr 1, 2025 Accepting new patients
Advanced Health Care Incorporated Current Accepting new patients
Northeast Health Services, LLC CurrentSince Dec 1, 2025 Accepting new patients
Whitman Counseling PastSince Feb 22, 2025 Accepting new patients

Locations

44 School St
Rm 325
Boston, MA 02108
Phone (508) 831-8558

1340 Soldiers Field Rd
Brighton, MA 02135
Phone (617) 307-3677

30 Taunton Grn
Ste 5
Taunton, MA 02780
Phone (508) 545-7400

288 Bedford St
Whitman, MA 02382
Phone (781) 447-6425

27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 5

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.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northeast Health Services LLC 470 clinicians
Brockton Area Multi-Services, Inc. 18 clinicians

Practice addresses (Care Compare)

1340 Soldiers Field Rd
Brighton, MA 02135-1000
Phone (617) 334-7393

288 Bedford St
Whitman, MA 02382-1820
Phone (781) 447-6425

NPI Registry JSON

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

{
    "created_epoch": "1707177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1043073539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 LANCASTER RD",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023684942",
            "telephone_number": "781-300-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 LANCASTER RD",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023684942",
            "telephone_number": "781-300-1495",
            "fax_number": "781-767-5939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IKEOGU",
        "first_name": "LYNDA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-06",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "271418",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN271418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, MA

Sources for this page

Verify at the official NPI Registry.