Individual provider Active NPI

Yekeen Odewale

  • Psychiatric/Mental Health Nurse Practitioner
  • Owings Mills, MD
National Provider Identifier
1184175697
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R212715 Issued in MD
Practice address
4515 Hidden Stream CT
Owings Mills, MD 21117-4837
Phone
(410) 300-6461
NPI assigned
Oct 19, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Registered NurseGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 163WP0809X R212715 MD
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R212715 MD Primary

Addresses

Primary practice location

4515 Hidden Stream CT
Owings Mills, MD 21117-4837

Mailing address

5411 Old Frederick Rd Ste 7
Baltimore, MD 21229-2126
Phone (410) 762-8945

Other practice location 1

5411 Old Frederick Rd Ste 7
Baltimore, MD 21229
Phone (410) 762-8945

Other identifiers 1

IdentifierTypeStateIssuer
117396100MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20180124000717 MD Practitioner - Nurse Practitioner 1759640592 Reassigns benefits to 1 organization
Practice locations: Baltimore, MD

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R212715MDMDAdult Psychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Safe Harbor Behavioral Care, LLC Single Specialty CurrentSince May 7, 2019 Accepting new patients
New Day Health Systems Inc Current Accepting new patients
New Day Health Systems, Inc. Current Accepting new patients
Adekomi Psychiatric Services LLC CurrentSince Feb 2, 2025 Accepting new patients
Adekomi Psychiatric Services LLC Psychiatric/Mental Health, Adult CurrentSince Feb 2, 2025 Accepting new patients

Locations

5411 Old Frederick Rd
Ste 7
Baltimore, MD 21229
Phone (410) 205-9013

1208 E Churchville Rd
Ste 300
Bel Air, MD 21014
Phone (410) 838-9500

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.

NPI Registry JSON

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1184175697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5411 OLD FREDERICK RD STE 7",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212292126",
            "telephone_number": "410-762-8945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 HIDDEN STREAM CT",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211174837",
            "telephone_number": "410-300-6461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5411 Old Frederick Rd Ste 7",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "21229",
            "country_code": "US",
            "telephone_number": "410-762-8945",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODEWALE",
        "first_name": "YEKEEN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-19",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MD",
            "license": "R212715",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R212715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117396100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owings Mills, MD

Sources for this page

Verify at the official NPI Registry.