Individual provider Active NPI

Sirah Leyere-Ue Okoluku

  • Psychiatric/Mental Health Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1942855523
Registry record updated Aug 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R175528 Issued in MD
Practice address
1501 Sulgrave Ave Ste 200
Baltimore, MD 21209-3650
Phone
(443) 708-5856
NPI assigned
Aug 9, 2019
Last updated
Aug 9, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 9, 2019

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 R175528 MD Primary

Addresses

Primary practice location

1501 Sulgrave Ave Ste 200
Baltimore, MD 21209-3650

Mailing address

2137 Streamway CT
Gwynn Oak, MD 21207-6093
Phone (443) 720-9292

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191210001531 DC Practitioner - Nurse Practitioner 3173956893 Reassigns benefits to 1 organization
I20211221002790 MD Practitioner - Nurse Practitioner 3173956893 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Health Care, LLC Current Accepting new patients
Premier Health Care LLC CurrentSince Nov 1, 2019 Accepting new patients

Locations

12073 Tech Rd
Ste B
Silver Spring, MD 20904
Phone (240) 396-5873

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1565308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565308800000",
    "number": "1942855523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2137 STREAMWAY CT",
            "city": "GWYNN OAK",
            "state": "MD",
            "postal_code": "212076093",
            "telephone_number": "443-720-9292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SULGRAVE AVE STE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093650",
            "telephone_number": "443-708-5856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKOLUKU",
        "first_name": "SIRAH",
        "middle_name": "LEYERE-UE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-09",
        "last_updated": "2019-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R175528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.