NPIMap

Organization Active NPI

Medical Community Psychotherapy LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Framingham, MA
National Provider Identifier
1346720646
Registry record updated Jan 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
MEDICAL COMMUNITY PSYCHOTHERAPY LLC
Practice address
264 Union Ave Apt 2
Framingham, MA 01702-6348
Phone
(508) 733-5951
Fax
(508) 321-1960
NPI assigned
Aug 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2021

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

Authorized official

Name
Dr. George Olusola Akinkuoye, PMHNP-BC, DNPNPI 1366796088
Title
President
Phone
(508) 733-5951

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WP0808X 233605 MA
Adult Psychiatric/Mental Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WP0809X
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

264 Union Ave Apt 2
Framingham, MA 01702-6348

Mailing address

264 Union Ave Apt 2
Framingham, MA 01702-6348
Phone (774) 244-4128

Other identifiers 3

IdentifierTypeStateIssuer
1366796088OtherMACOMMONWEALTH CARE ALLIANCE
110110469AMedicaidMA
1366796088OtherMABLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190905002391 MA Part B Supplier - Clinic/Group Practice 6800125527 Receives reassigned benefits from 5 practitioners
Practice locations: Natick, MA

National Provider Directory

National Provider Directory

Locations

209 W Central St
Ste 209
Natick, MA 01760
Phone (508) 733-5951

Practitioners & affiliated clinicians

Practitioners 5

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": "1534377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610064000000",
    "number": "1346720646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 UNION AVE APT 2",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017026348",
            "telephone_number": "774-244-4128",
            "fax_number": "774-244-4129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 UNION AVE APT 2",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017026348",
            "telephone_number": "508-733-5951",
            "fax_number": "508-321-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL COMMUNITY PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-16",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A",
        "authorized_official_last_name": "AKINKUOYE",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "OLUSOLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "508-733-5951",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PMHNP-BC, DNP"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MA",
            "license": "233605",
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMONWEALTH CARE ALLIANCE",
            "identifier": "1366796088",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110110469A",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1366796088",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Framingham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; 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.