Individual provider Active NPI

Romi Lyallpuri

  • Psychiatric/Mental Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1144930686
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
405993-01 Issued in NY
Practice address
274 Madison Ave RM 1501
New York, NY 10016-0701
Phone
(212) 203-1773
NPI assigned
Nov 23, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 2, 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 856776-01 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 405993-01 NY Primary

Addresses

Primary practice location

274 Madison Ave RM 1501
New York, NY 10016-0701

Mailing address

23 Caldwell Rd
Valley Stream, NY 11580-1911
Phone (631) 645-3608

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20241206000342 NY Practitioner - Nurse Practitioner 4082140611 Reassigns benefits to 1 organization

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
Rivia Medical PLLCGroup PAC ID 4880009943, 67 clinicians

Practice addresses (Care Compare)

350 E Ave
Suite 203
Rochester, NY 14604-2604
Phone (212) 203-1773

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
856776-01NYMDRegistered Nurse
405993-01NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rivia Medical PLLC CurrentSince Dec 2, 2024 Accepting new patients
Rivia Medical PLLC Psychiatric/Mental Health CurrentSince Dec 2, 2024 Accepting new patients

Locations

401 New Karner Rd
Ste 301
Albany, NY 12205
Phone (212) 203-1173

274 Madison Ave
Rm 1501
New York, NY 10016
Phone (212) 202-1773

350 East Ave
Ste 203
Rochester, NY 14604

Organizations & group practices 2

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": "1669161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1144930686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 CALDWELL RD",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115801911",
            "telephone_number": "631-645-3608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "274 MADISON AVE RM 1501",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100160701",
            "telephone_number": "212-203-1773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYALLPURI",
        "first_name": "ROMI",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-23",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "856776-01",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "405993-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.