Okechukwu C Chidiadi, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · South Windsor, CT
NPI 1457922692 · NPPES record last updated Oct 25, 2021
Key facts
- NPI
- 1457922692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 009779 (CT)
- Practice address
- 92 Mark Dr
South Windsor, CT 06074-1435 - Phone
- (860) 869-5030
- NPI assigned
- Jul 8, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
116 Cottage Grove Rd
Suite 110
Bloomfield, CT 06002-3200
Phone (860) 904-5433
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211203000146 | CT | Practitioner - Nurse Practitioner | 7416347570 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009779 | CT | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Step Up Care PC LLC | Current |
Accepting new patients | |
| Holistic Behavioral Health of Connecticut LLC | Psychiatric/Mental Health | Current |
Accepting new patients |
| Prospect Manchester Hospital, Inc. | Psychiatric/Mental Health | Current |
Accepting new patients |
| Eastern Connecticut Medical Professionals Foundation, Inc | Past | Accepting new patients |
Locations
116 Cottage Grove Rd
Ste 110
Bloomfield, CT 06002
Phone (612) 481-7636
33 Lincoln Ave
Danbury, CT 06810
Phone (203) 797-9300
71 Haynes St
Manchester, CT 06040
Phone (860) 533-2981
27 Randolph Rd
#A
Howell, NJ 07731
Phone (732) 797-9290
27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 009779 | CT | Yes |
Addresses
Primary practice location
92 Mark Dr
South Windsor, CT 06074-1435
Mailing address
92 Mark Dr
South Windsor, CT 06074-1435
Phone (860) 869-5030
Other providers in South Windsor, CT
- Central Connecticut Gastroenterology LLC
- Central CT Wellness, LLC
- Aimee Chandler
- John Jason Chapman
- Wing Cheung
- Dayna Chinsky
- Jack M. Chinsky
- Christa Madden MSW LCSW LLC
- Zozan Chweich
- Abigail Coromoto Cipriani Amador
All providers in South Windsor, CT · Psychiatric/Mental Health Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.