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KEMISOLA LYNDA EBIETOMIYE
NPI 1255102976
Nurse Practitioner - Psychiatric/Mental Health in New York, NY

Active since January 11, 2024PECOS EnrolledAccepts Medicare Assignment
274 MADISON AVE RM 1501, NEW YORK, NY 10016(212) 203-1773(646) 665-4427 Get Directions Write a Review

NPPES record last updated: July 7, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 7, 2025, May 14, 2025, Oct 11, 2024 (3 updates tracked since 2024).

About Kemisola Lynda Ebietomiye NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEMISOLA LYNDA EBIETOMIYE (NPI 1255102976) is an individual psychiatric/mental health provider in New York, New York, licensed in New York (405625) and active in the NPI registry since January 2024. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1255102976
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameKEMISOLA LYNDA EBIETOMIYE
Location Address274 MADISON AVE RM 1501New York, NY 10016-0701
Mailing Address548 Westwood Way DrHaslet, TX 76052-3079 · (469) 250-1544 · Fax (469) 242-9827
Phone(212) 203-1773
Fax(646) 665-4427
Sole ProprietorYes
Medical School CMSOtherGraduated 2023
Enumeration DateJanuary 11, 2024
Last NPPES UpdateJuly 7, 20253 updates tracked since enumeration
NPPES CertifiedJuly 7, 2025
✔ NPI 1255102976 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
Licenses✔ Licensed in NY · 405625✔ Licensed in TX · 1149539✔ Licensed in NJ · 26NJ15047800
274 MADISON AVE RM 1501, New York, NY 10016
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1801 7th AveFort Worth, TX 76104-2733 · Phone (773) 621-8983 · Fax (469) 242-9827
Location 22 University Plz Ste 100Hackensack, NJ 07601-6210 · Phone (212) 203-1773 · Fax (646) 665-4427

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Texas, Cigna Healthcare and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kemisola Lynda Ebietomiye is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7719322726
PECOS Enrollment IDI20260601003926
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

4

Medicare enrollment records show Kemisola Ebietomiye reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Rivia Medical PLLC
Same address
Psychiatric/Mental Health
274 MADISON AVE RM 1501
New York, NY 10016
  • Reassigned Medicare billing, New Jersey and New York enrollments
  • 29 clinicians in this Medicare group
NPI 1134644032 (212) 203-1773
Grow Healthcare Group Of New Jersey PC
2.6 mi
Mental Health
221 RIVER ST. FL 9
Hoboken, NJ 07030
  • Reassigned Medicare billing, New Jersey enrollment
  • 673 clinicians in this Medicare group
NPI 1841949328 (201) 439-8902
Grow Healthcare Group PA
1,092 mi
Mental Health
66 W FLAGLER ST STE 900
Miami, FL 33130
  • Reassigned Medicare billing, Arizona, Connecticut, Illinois, Massachusetts, Minnesota, New Mexico, New York, Texas and Washington enrollments
  • 532 clinicians in this Medicare group
NPI 1245845932 (786) 244-7711
Ruby Reflections Mental Health LLC
1,397 mi
Psychiatric/Mental Health
548 WESTWOOD WAY DR
Haslet, TX 76052
  • Reassigned Medicare billing, Texas enrollment
NPI 1356182380 (469) 250-1544

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10016 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$102.04 typical visit price
range $65.69 – $198.19
Typical copayment $25.51 (range $16.42 – $49.54)
Most-billed visit code 99203
Established Patient
$114.88 typical visit price
range $21.20 – $160.66
Typical copayment $28.72 (range $5.30 – $40.16)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. MONIQUE ZELLARS
Social Worker (Clinical)
274 MADISON AVE RM 1501
NEW YORK, NY 10016
New York County (212) 203-1773
DIANA VELIZ LCSW
Social Worker (Clinical)
274 MADISON AVE RM 1501
NEW YORK, NY 10016
New York County (212) 203-1773
DANICA MCCANN LCSW
Social Worker (Clinical)
274 MADISON AVE RM 1501
NEW YORK, NY 10016
New York County (212) 203-1773
MS. PHUC DUYEN NGUYEN
Nurse Practitioner (Psychiatric/Mental Health)
274 MADISON AVE RM 1501
NEW YORK, NY 10016
New York County (212) 203-1773
JOHN WILLIAM SCANDURRA PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
274 MADISON AVE RM 1501
NEW YORK, NY 10016
New York County (212) 203-1773
DIANA M GOMEZ NP
Nurse Practitioner (Psychiatric/Mental Health)
274 MADISON AVE RM 1501
NEW YORK, NY 10016
New York County (212) 203-1773
DANDAN WANG
Nurse Practitioner (Psychiatric/Mental Health)
274 MADISON AVE RM 1501
NEW YORK, NY 10016
New York County (212) 203-1773
MICHELLE COHEN PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
274 MADISON AVE RM 1501
NEW YORK, NY 10016
New York County (201) 774-1122

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kemisola Ebietomiye's NPI number?

The NPI number for Kemisola Ebietomiye is 1255102976. It was assigned to this individual provider in the NPPES registry on January 11, 2024.

Where is Kemisola Ebietomiye located?

Kemisola Ebietomiye practices at 274 Madison Ave Rm 1501, New York, NY 10016. The listed phone number is (212) 203-1773.

What is Kemisola Ebietomiye's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Kemisola Ebietomiye enrolled in Medicare?

Yes. Kemisola Ebietomiye is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Kemisola Ebietomiye's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kemisola Ebietomiye reassigns Medicare benefits to 4 organizations: Rivia Medical PLLC (New York, NY), Grow Healthcare Group Of New Jersey PC (Hoboken, NJ), Grow Healthcare Group PA (Miami, FL) and Ruby Reflections Mental Health LLC (Haslet, TX). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kemisola Ebietomiye's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kemisola Ebietomiye accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Texas, Cigna Healthcare, Harvard Pilgrim Health Care and Molina Healthcare and 4 other insurers list Kemisola Ebietomiye as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kemisola Ebietomiye was last updated on July 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.