Active NPI
Boluwaji Iyiola
- Psychiatric/Mental Health Nurse Practitioner
- Indianapolis, IN
National Provider Identifier
1669280293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 71016263A
- Practice address
- 4102 Shore Dr
Indianapolis, IN 46254-2608 - Phone
- (317) 597-2117
- NPI assigned
- Dec 30, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 71016263A | IN | Primary |
Addresses
Primary practice location
4102 Shore Dr
Indianapolis, IN 46254-2608
Mailing address
4008 Radley CT
Danville, IN 46122-9179
Phone (309) 203-6902
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
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
Practice addresses (Care Compare)
5226 E 82ND St
Indianapolis, IN 46250-1628
Phone (513) 489-7100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CNP Operating Co LLC | Current | Accepting new patients | |
| Mental Health Specialty Group PA | Current | Accepting new patients |
Locations
4102 Shore Dr
Indianapolis, IN 46254
Phone (317) 347-9051
333 N Alabama St
Indianapolis, IN 46204
Phone (317) 395-3391
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": "1735516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744329600000",
"number": "1669280293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4008 RADLEY CT",
"city": "DANVILLE",
"state": "IN",
"postal_code": "461229179",
"telephone_number": "309-203-6902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4102 SHORE DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462542608",
"telephone_number": "317-597-2117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IYIOLA",
"first_name": "BOLUWAJI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-30",
"last_updated": "2025-04-11",
"certification_date": "2025-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "IN",
"license": "71016263A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2025; 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.