Samuel Olaoluwa Omolade, APRN PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1099855 Issued in TX

Practice address

11650 McCree Rd
Dallas, TX 75238-5224

Phone

(718) 304-4906

NPI assigned

Jun 7, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, NY, DC, CO, IA, NH, WA, NM8 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 8

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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 and National Provider Directory roles.

• Kinghaven Counseling Group Inc

  • Case Management Agency
  • Houston, TX
  • NPI 1396807350
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  CO, DC, IA, NH, NM, NY, Psychiatric/Mental Health, TX, WA

  Medicare reassignment NPD
• Samz Mental Health LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Austin, TX
  • NPI 1457123846
  NPD Authorized official
• Adel Health Care Services LLC

  • Home Health Agency
  • Missouri City, TX
  • NPI 1659925394

  Case Manager/Care Coordinator

  NPD (past)

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689379200000",
    "number": "1548799141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11650 MCCREE RD APT 2034",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752383245",
            "telephone_number": "718-304-4906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11650 MCCREE RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752385224",
            "telephone_number": "718-304-4906"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1904 Arnow Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104693334",
            "country_code": "US",
            "telephone_number": "718-304-4906",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OMOLADE",
        "first_name": "SAMUEL",
        "middle_name": "OLAOLUWA",
        "name_prefix": "Mr.",
        "credential": "APRN PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-07",
        "last_updated": "2023-07-15",
        "certification_date": "2023-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "320878-1",
            "primary": false
        },
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "TX",
            "license": "958104",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "TX",
            "license": "958104",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61366158",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1099855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Omnicare Laboratory LLC
• Omnihealth Nutrition
• Omnimed Consulting LLC
• Staton Omo-Abu
• Jessica Omoegbele, MSN, FNP-BC
• Rabiu E Omolaja, LPC
• Onikepo O Omonira, AGACNP-BC
• Rabi Omonua
• Islamia A Omoola, REGISTERED NURSE
• Owen O Omoragbon, NP

• Psychiatric/Mental Health Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2023; 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.