ELLYA INDRADJAJA LMHC
NPI 1659024867
Counselor - Mental Health in Astoria, NY
About Ellya Indradjaja Lmhc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ELLYA INDRADJAJA LMHC (NPI 1659024867) is an individual mental health provider in Astoria, New York, licensed in New York (011692) and active in the NPI registry since January 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2018).
NPPES Registry Identity
Specialties & Licenses
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
Ellya Indradjaja Lmhc 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.
Medicare Billing Reassignment
Medicare enrollment records show Ellya Indradjaja reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Durham, NC 27701
- Reassigned Medicare billing, New York enrollment
- 144 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Ellya Indradjaja's NPI number?
The NPI number for Ellya Indradjaja is 1659024867. It was assigned to this individual provider in the NPPES registry on January 27, 2022.
Where is Ellya Indradjaja located?
Ellya Indradjaja practices at 3089 31st St Apt 1, Astoria, NY 11102. The listed phone number is (646) 377-9724.
What is Ellya Indradjaja's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Ellya Indradjaja enrolled in Medicare?
Yes. Ellya Indradjaja 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 organization bills Medicare for Ellya Indradjaja's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Ellya Indradjaja reassigns Medicare benefits to Mental Health Specialty Group PA (Durham, NC). 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 Ellya Indradjaja'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 Ellya Indradjaja was last updated on January 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.
# Ellya Indradjaja, LMHC · NPI 1659024867
Mental Health provider in Astoria, New York. Individual provider, active in the CMS NPPES registry since January 27, 2022.
## Identity
- **NPI:** 1659024867 (Entity type: Individual)
- **Enumerated:** January 27, 2022
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **State license:** 011692 (New York)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 3089 31ST ST APT 1, Astoria, NY 11102-1975
- **Phone:** (646) 377-9724
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Mental Health Specialty Group PA (NPI 1801472634, Durham, NC), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2018
## Record status
- **NPPES last updated:** January 27, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1659024867) · Data from the CMS NPPES public registry.