NPIMap

Organization Active NPI

Icon Clinic LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Greenbelt, MD
National Provider Identifier
1245808666
Registry record updated Apr 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
ICON CLINIC LLC
Practice address
7735 Belle Point Dr
Greenbelt, MD 20770-3300
Phone
(240) 455-3166
Fax
(240) 455-4154
NPI assigned
Jun 13, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2026

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

Authorized official

Name
Mr. Thickness Patrick Egwuatu, BC-PMHNPNPI 1053997122
Title
Provider/Ceo
Phone
(202) 288-7752

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

7735 Belle Point Dr
Greenbelt, MD 20770-3300

Mailing address

7735 Belle Point Dr
Greenbelt, MD 20770-3300
Phone (240) 455-3166

Other practice location 1

2000 Rhode Island Ave NE
Washington, DC 20018-2835
Phone (240) 455-3166 ext. 30

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210914000306 DC Part B Supplier - Clinic/Group Practice 7719383967 Receives reassigned benefits from 1 practitioner
Practice locations: Greenbelt, MD; Washington, DC

National Provider Directory

National Provider Directory
Tax ID family
Icon Clinic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

  • Icon Clinic LLC
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Greenbelt, MD
    • NPI 1659090934
    NPD tax ID

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1623542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777507200000",
    "number": "1245808666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7735 BELLE POINT DR",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207703300",
            "telephone_number": "240-455-3166",
            "fax_number": "240-455-4154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7735 BELLE POINT DR",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207703300",
            "telephone_number": "240-455-3166",
            "fax_number": "240-455-4154"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Rhode Island Ave NE",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200182835",
            "country_code": "US",
            "telephone_number": "240-455-3166 x30",
            "fax_number": "240-455-4154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ICON CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-13",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A",
        "authorized_official_last_name": "EGWUATU",
        "authorized_official_first_name": "THICKNESS",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "PROVIDER/CEO",
        "authorized_official_telephone_number": "202-288-7752",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BC-PMHNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbelt, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.