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OLUWAKEMISOLA ABIODUN KOKU
NPI 1619812427
Nurse Practitioner - Psychiatric/Mental Health in Waldorf, MD

Active since April 20, 2026PECOS Enrolled
4665 PEBBLE BEACH CT, WALDORF, MD 20602(737) 268-9101 Get Directions Write a Review

NPPES record last updated: August 17, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 17, 2026, Apr 20, 2026 (2 updates tracked since 2026).

About Oluwakemisola Abiodun Koku NPPES

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

OLUWAKEMISOLA ABIODUN KOKU (NPI 1619812427) is an individual psychiatric/mental health provider in Waldorf, Maryland, licensed in Pennsylvania (SP034976) and active in the NPI registry since April 2026. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1619812427
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameOLUWAKEMISOLA ABIODUN KOKU
Location Address4665 PEBBLE BEACH CTWaldorf, MD 20602-4110
Mailing Address4665 Pebble Beach CtWaldorf, MD 20602-4110 · (737) 268-9101
Phone(737) 268-9101
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateApril 20, 2026
Last NPPES UpdateAugust 17, 20262 updates tracked since enumeration
NPPES CertifiedAugust 17, 2026
✔ NPI 1619812427 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
License✔ Licensed in PA · SP034976
4665 PEBBLE BEACH CT, Waldorf, MD 20602
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Oluwakemisola Abiodun Koku is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5991264988
PECOS Enrollment IDI20260831000002
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 Reassignment

Medicare enrollment records show Oluwakemisola Koku reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Beta Behavioral Health Services LLC
131 mi
Psychiatry
300 E LANCASTER AVE STE 106A
Wynnewood, PA 19096
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 3 clinicians in this Medicare group
NPI 1821846858 (267) 442-8172

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 20602 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
$89.75 typical visit price
range $57.99 – $175.57
Typical copayment $22.43 (range $14.49 – $43.89)
Most-billed visit code 99203
Established Patient
$102.11 typical visit price
range $18.66 – $143.02
Typical copayment $25.52 (range $4.66 – $35.75)
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.

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 Oluwakemisola Koku's NPI number?

The NPI number for Oluwakemisola Koku is 1619812427. It was assigned to this individual provider in the NPPES registry on April 20, 2026.

Where is Oluwakemisola Koku located?

Oluwakemisola Koku practices at 4665 Pebble Beach Ct, Waldorf, MD 20602. The listed phone number is (737) 268-9101.

What is Oluwakemisola Koku's specialty?

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

Is Oluwakemisola Koku enrolled in Medicare?

Yes. Oluwakemisola Koku is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Oluwakemisola Koku's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Oluwakemisola Koku reassigns Medicare benefits to Beta Behavioral Health Services LLC (Wynnewood, PA). The 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 Oluwakemisola Koku's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Oluwakemisola Koku was last updated on August 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.