Individual provider Active NPI

Rosevelt Salvatore Nwokeji, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Boston, MA
National Provider Identifier
1568133569
Registry record updated Nov 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN2337837 Issued in MA
Practice address
85 E Newton St
Boston, MA 02118-3553
Phone
(617) 626-8700
NPI assigned
Sep 21, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN2337837 MA Primary

Addresses

Primary practice location

85 E Newton St
Boston, MA 02118-3553

Mailing address

85 E Newton St
Boston, MA 02118-3553
Phone (617) 626-8944

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20221104000099 MA Practitioner - Nurse Practitioner 4183091192 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Commonwealth of Massachusetts CurrentSince Jul 9, 2022 Accepting new patients
The Commonwealth of Massachusetts CurrentSince Apr 29, 2024 Accepting new patients
The Commonwealth of Massachusetts CurrentSince Jul 9, 2022 Accepting new patients

Locations

85 Newton St
Boston, MA 02118
Phone (617) 305-9960

365 East St
Tewksbury, MA 01876
Phone (617) 536-2186

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636416000000",
    "number": "1568133569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 E NEWTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021183553",
            "telephone_number": "617-626-8944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 E NEWTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021183553",
            "telephone_number": "617-626-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWOKEJI",
        "first_name": "ROSEVELT",
        "middle_name": "SALVATORE",
        "name_prefix": "Mr.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-21",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2337837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.