Individual provider Active NPI

Tyrone O'Banner

  • Psychiatric/Mental Health Nurse Practitioner
  • Springfield, MA
National Provider Identifier
1598482580
Registry record updated May 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN10003790 Issued in MA
Practice address
417 Liberty St
Springfield, MA 01104-3736
Phone
(413) 301-9355
NPI assigned
Oct 20, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN10003790 MA Primary
Psychiatric/Mental Health Registered Nurse 163WP0808X RN2345699 MA

Addresses

Primary practice location

417 Liberty St
Springfield, MA 01104-3736

Mailing address

PO Box 6768
Holyoke, MA 01041-6768
Phone (413) 218-4888

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
I20250623000358 MA Practitioner - Nurse Practitioner 9931611308 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Behavioral Health Network IncGroup PAC ID 3072596360, 146 clinicians

Practice addresses (Care Compare)

417 Liberty St
Springfield, MA 01104-3736
Phone (413) 736-3668

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN2345699MAMDPsychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Health Network, Inc CurrentSince May 14, 2025 Accepting new patients
Behavioral Health Network Inc CurrentSince May 14, 2025 Accepting new patients

Locations

40 Bobala Rd
Holyoke, MA 01040
Phone (413) 536-5473

417 Liberty St
Springfield, MA 01104
Phone (413) 733-6661

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1666224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746144000000",
    "number": "1598482580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6768",
            "city": "HOLYOKE",
            "state": "MA",
            "postal_code": "010416768",
            "telephone_number": "413-218-4888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 LIBERTY ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011043736",
            "telephone_number": "413-301-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BANNER",
        "first_name": "TYRONE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-20",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "APRN10003790",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2345699",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

Verify at the official NPI Registry.