Oghenero Lucky Olomukoro, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209025704 Issued in IL

Practice address

4 Memorial Dr Ste 210
Alton, IL 62002-6704

Phone

(618) 465-8829

Fax

(618) 465-5499

NPI assigned

Mar 29, 2022

Last updated

Oct 12, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, MO2 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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Comprehensive Behavioral Health Center of St. Clair County, Inc.Group PAC ID 7810072899, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Touchette Regional Hospital Inc Hospital, Centreville, IL, CCN 140077

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Comprehensive Behavioral Health Center of St. Clair County, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • East Saint Louis, IL
  • NPI 1720094345
  Medicare reassignment Care Compare group NPD
• Springs of Healing LLC

  • Psychiatric/Mental Health Registered Nurse
  • Belleville, IL
  • NPI 1902773450

  MO

  Medicare reassignment NPD Authorized official
• Illinois Department of Human Services

  • Intellectual Disabilities Intermediate Care Facility
  • Centralia, IL
  • NPI 1003960394
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  IL, Psychiatric/Mental Health

  Medicare reassignment NPD
• Homeplace Healthcare LLC

  • Home Health Agency
  • Saint Louis, MO
  • NPI 1336700616
  NPD Authorized official
• Comprehensive Behavioral Health Center of St. Clair County, Inc.

  • Methadone Clinic
  • East Saint Louis, IL
  • NPI 1437328283
  NPD
• Comprehensive Mental Health Center of St. Clair County, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Belleville, IL
  • NPI 1912176900
  NPD
• Illinois Department of Human Services

  • Psychiatric Hospital
  • Chester, IL
  • NPI 1306834726
  NPD
• Illinois Department of Human Services

  dba John J Madden Mental Health

  • Psychiatric Hospital
  • Hines, IL
  • NPI 1902903487
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Touchette Regional Hospital Inc

  dba Touchette Geriatric Behavioral Health Services

  • Psychiatric Hospital Unit
  • Cahokia Heights, IL
  • NPI 1750992459
  Care Compare affiliation
• Touchette Regional Hospital Inc

  • Emergency Medicine Physician
  • Cahokia Heights, IL
  • NPI 1922019926

  Hospital

  Care Compare affiliation
• Touchette Regional Hospital, Inc.

  • General Acute Care Hospital
  • Cahokia Heights, IL
  • NPI 1427111046
  Care Compare affiliation

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

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665532800000",
    "number": "1437899689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MEMORIAL DR STE 210",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026704",
            "telephone_number": "618-465-8829",
            "fax_number": "618-465-5499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MEMORIAL DR STE 210",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026704",
            "telephone_number": "618-465-8829",
            "fax_number": "618-465-5499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13675 Evergreen Glen Dr",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631284273",
            "country_code": "US",
            "telephone_number": "410-574-4955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLOMUKORO",
        "first_name": "OGHENERO",
        "middle_name": "LUCKY",
        "name_prefix": "Mr.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-29",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209025704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "oghenero.olomukoro.1@9559.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "4 Memorial Dr Ste 210",
            "city": "Alton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620026704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• NW Rehab, L.L.C.
• Chelsea O'Connell, MSW.LSW
• Katelyn Elizabeth Oexmann, DDS
• Marilyn Ojeda, CRNA
• Kasiemobi Bernice Okonkwo, MD
• Aaron Patrick Omotola, M.D.
• Mohamedtarek A Omran, BDS
• Marissa Anne Ontis, FNP-C
• Kelsey Marie Orf, AGNP
• Samantha Orlandini, AS

• Psychiatric/Mental Health Nurse Practitioner in Alton, IL
• Providers in Alton, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.