Individual provider Active NPI

Priscilla I Nwachukwu, NP

  • Adult Health Nurse Practitioner
  • Waltham, MA
National Provider Identifier
1982872651
Registry record updated Feb 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
194268 Issued in MA
Practice address
200 Trapelo Rd
Waltham, MA 02452-6332
Phone
(781) 894-3600
NPI assigned
Feb 15, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X 194268 MA Primary

Addresses

Primary practice location

200 Trapelo Rd
Waltham, MA 02452-6332

Mailing address

200 Trapelo Rd
Waltham, MA 02452-6332
Phone (781) 894-3600

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
I20050113000202 MA Practitioner - Nurse Practitioner 6204885684 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ideal Healthcare Solutions LLCGroup PAC ID 0042376899, 9 clinicians
Metis Psychological AssociatesGroup PAC ID 9335295682, 3 clinicians

Practice addresses (Care Compare)

19 Henry St
Sharon, MA 02067-1714
Phone (781) 562-0468

420 Main St
Suite 21
Walpole, MA 02081-3753
Phone (781) 963-1200

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
194268MAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Healthcare Solutions LLC Single Specialty CurrentSince Mar 1, 2009 Accepting new patients
Metis Psychological Associates Single Specialty CurrentSince Dec 10, 2012 Accepting new patients
NP Care of Massachusetts LLC Single Specialty Past Accepting new patients
Liberty Health Care Corporation Single Specialty Past Accepting new patients

Locations

50 Oliver St
Ste 211
North Easton, MA 02356
Phone (508) 294-8256

490 N Main St
Ste 2
Randolph, MA 02368
Phone (781) 963-1200

420 Main St
Ste 21
Walpole, MA 02081
Phone (781) 963-1200

Organizations & group practices 4

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": "1203033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203033600000",
    "number": "1982872651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 TRAPELO RD",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024526332",
            "telephone_number": "781-894-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TRAPELO RD",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024526332",
            "telephone_number": "781-894-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWACHUKWU",
        "first_name": "PRISCILLA",
        "middle_name": "I",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-15",
        "last_updated": "2008-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "194268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

Verify at the official NPI Registry.