Individual provider Active NPI

Sunday Ezekiel Ayodele, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Washington, DC
National Provider Identifier
1063137156
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
NP1033776 Issued in DC
Practice address
3291 Fort Lincoln Dr NE
Washington, DC 20018-4316
Phone
(202) 607-5164
NPI assigned
Oct 11, 2022
Last updated
Oct 11, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X NP1033776 DC Primary

Addresses

Primary practice location

3291 Fort Lincoln Dr NE
Washington, DC 20018-4316

Mailing address

3291 Fort Lincoln Dr NE
Washington, DC 20018-4316
Phone (202) 607-5164

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL WWW. Health Information Exchange (HIE)
FHIR URL WWW. Health Information Exchange (HIE)
FHIR URL WWW Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230427000358 MD Practitioner - Nurse Practitioner 6608231642 Reassigns benefits to 1 organization
I20230427001027 DC Practitioner - Nurse Practitioner 6608231642 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Psychogeriatric Services LLCGroup PAC ID 6002719226, 122 clinicians

Practice addresses (Care Compare)

12073 Tech Rd
Suite B
Silver Spring, MD 20904-7874
Phone (301) 593-1315

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NP1033776DCMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Psychogeriatric Services LLC Single Specialty CurrentSince Apr 6, 2023 Accepting new patients

Locations

4101 Old National Pike
Mount Airy, MD 21771
Phone (301) 829-0800

12073 Tech Rd
Ste B
Silver Spring, MD 20904
Phone (240) 396-5873

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": "1665446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1063137156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3291 FORT LINCOLN DR NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200184316",
            "telephone_number": "202-607-5164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3291 FORT LINCOLN DR NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200184316",
            "telephone_number": "202-607-5164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYODELE",
        "first_name": "SUNDAY",
        "middle_name": "EZEKIEL",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-11",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "DC",
            "license": "NP1033776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "WWW.",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3291 Fort Lincoln Dr NE",
            "city": "Washington",
            "state": "DC",
            "country_code": "US",
            "postal_code": "200184316",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "WWW.",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3291 Fort Lincoln Dr NE",
            "city": "Washington",
            "state": "DC",
            "country_code": "US",
            "postal_code": "200184316",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "WWW",
            "affiliation": "N",
            "endpointDescription": "API",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3291 Fort Lincoln Dr NE",
            "city": "Washington",
            "state": "DC",
            "country_code": "US",
            "postal_code": "200184316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.