Individual provider Active NPI

John Bethel Kwabena Owusu Jr., PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Hyattsville, MD
National Provider Identifier
1124842711
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R223676 Issued in MD
Practice address
6475 New Hampshire Ave Ste 504R
Hyattsville, MD 20783-3279
Phone
(240) 512-6015
NPI assigned
Nov 11, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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 Practitioner 363LP0808X R223676 MD Primary

Addresses

Primary practice location

6475 New Hampshire Ave Ste 504R
Hyattsville, MD 20783-3279

Mailing address

6475 New Hampshire Ave Ste 504R
Hyattsville, MD 20783-3279
Phone (240) 512-6015

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 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
I20250207002710 DC Practitioner - Nurse Practitioner 8729518584 Reassigns benefits to 3 organizations
I20250207003112 MD Practitioner - Nurse Practitioner 8729518584 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Toller Enterprises, LLCGroup PAC ID 8628481926, 63 clinicians

Practice addresses (Care Compare)

2232 E Monument St
Baltimore, MD 21205-2431
Phone (667) 207-3552

3210 Powder Mill Rd
Hyattsville, MD 20783-1029
Phone (301) 937-3939

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R223676MDMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Integrahealth LLC Psychiatric/Mental Health CurrentSince Jan 30, 2025 Accepting new patients
Spiritual Healing Psychiatric/Mental Health CurrentSince Jan 1, 2025 Accepting new patients
Toller Enterprises LLC Psychiatric/Mental Health CurrentSince Jan 1, 2025 Accepting new patients
Integrahealth LLC Psychiatric/Mental Health CurrentSince Jan 30, 2025 Accepting new patients
Integrahealth LLC Psychiatric/Mental Health CurrentSince Jan 30, 2025 Accepting new patients

Locations

1500 K St NW
Ste 200
Washington, DC 20005
Phone (667) 207-3552

821 N Charles St
Baltimore, MD 21201
Phone (443) 452-9612

2232 E Monument St
Baltimore, MD 21205
Phone (667) 207-3552

10 N Rock Glen Rd
Baltimore, MD 21229
Phone (410) 646-2100

3210 Powder Mill Rd
Hyattsville, MD 20783
Phone (301) 937-3939

9722 Groffs Mill Dr
Owings Mills, MD 21117
Phone (410) 205-9255

200 Civic Ave
Salisbury, MD 21804
Phone (410) 749-1466

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1731283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1124842711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6475 NEW HAMPSHIRE AVE STE 504R",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207833279",
            "telephone_number": "240-512-6015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6475 NEW HAMPSHIRE AVE STE 504R",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207833279",
            "telephone_number": "240-512-6015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWABENA OWUSU",
        "first_name": "JOHN",
        "middle_name": "BETHEL",
        "name_suffix": "Jr.",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-11-11",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R223676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hyattsville, MD

Sources for this page

Verify at the official NPI Registry.