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BOLUWAJI IYIOLA
NPI 1669280293
Nurse Practitioner - Psychiatric/Mental Health in Indianapolis, IN

Active since December 30, 2024PECOS EnrolledAccepts Medicare Assignment
4102 SHORE DR, INDIANAPOLIS, IN 46254(317) 597-2117 Get Directions Write a Review

NPPES record last updated: April 11, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 11, 2025, Dec 30, 2024 (2 updates tracked since 2024).

About Boluwaji Iyiola NPPES

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

BOLUWAJI IYIOLA (NPI 1669280293) is an individual psychiatric/mental health provider in Indianapolis, Indiana, licensed in Indiana (71016263A) and active in the NPI registry since December 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1669280293
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameBOLUWAJI IYIOLA
Location Address4102 SHORE DRIndianapolis, IN 46254-2608
Mailing Address4008 Radley CtDanville, IN 46122-9179 · (309) 203-6902
Phone(317) 597-2117
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateDecember 30, 2024
Last NPPES UpdateApril 11, 20252 updates tracked since enumeration
NPPES CertifiedApril 11, 2025
✔ NPI 1669280293 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 IN · 71016263A
4102 SHORE DR, Indianapolis, IN 46254
Open in Google Maps ↗

Accepted Insurance

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

Boluwaji Iyiola 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 ID1355868514
PECOS Enrollment IDI20250510000155
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

3

Medicare enrollment records show Boluwaji Iyiola reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mental Health Specialty Group PA
482 mi
Mental Health
110 N CORCORAN ST FL 5
Durham, NC 27701
  • Reassigned Medicare billing, Indiana enrollment
  • 77 clinicians in this Medicare group
NPI 1801472634 (323) 205-7088
Grow Healthcare Group PA
1,031 mi
Mental Health
66 W FLAGLER ST STE 900
Miami, FL 33130
  • Reassigned Medicare billing, Indiana enrollment
  • 417 clinicians in this Medicare group
NPI 1245845932 (786) 244-7711
Cnp Operating Co LLC
  • Reassigned Medicare billing, Indiana enrollment
  • 50 clinicians in this Medicare group
No phone listed

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 46254 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
$82.04 typical visit price
range $53.07 – $161.76
Typical copayment $20.51 (range $13.26 – $40.44)
Most-billed visit code 99203
Established Patient
$94.22 typical visit price
range $16.93 – $132.22
Typical copayment $23.55 (range $4.23 – $33.05)
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 17

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

KRISTEN NICOLE MELANDER M.A. CCC-SLP
Speech-Language Pathologist
4102 SHORE DR
INDIANAPOLIS, IN 46254
Marion County (317) 347-9051
SHORE BEHAVIORAL LLC
Clinic/Center (Rehabilitation, Substance Use Disorder)
4102 SHORE DR
INDIANAPOLIS, IN 46254
Marion County (513) 489-7100
YOLANDA CARRIE JONES MSW, LSW
Social Worker
4102 SHORE DR
INDIANAPOLIS, IN 46254
Marion County (328) 027-0017
JERRY JONES PTA
Physical Therapy Assistant
4102 SHORE DR
INDIANAPOLIS, IN 46254
Marion County (317) 347-9051
NOELLE HORAN
Registered Nurse
4102 SHORE DR
INDIANAPOLIS, IN 46254
Marion County (317) 280-2700
MRS. PAULA ELIZABETH ADAMS COTA
Occupational Therapy Assistant
4102 SHORE DR
INDIANAPOLIS, IN 46254
Marion County (317) 347-9051
JULIET UJUNWA CHINWEZE PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
4102 SHORE DR
INDIANAPOLIS, IN 46254
Marion County (317) 280-2718
LYNX INDIANA LLC
Ambulance
4102 SHORE DR
INDIANAPOLIS, IN 46254
Marion County (317) 347-9051

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 Boluwaji Iyiola's NPI number?

The NPI number for Boluwaji Iyiola is 1669280293. It was assigned to this individual provider in the NPPES registry on December 30, 2024.

Where is Boluwaji Iyiola located?

Boluwaji Iyiola practices at 4102 Shore Dr, Indianapolis, IN 46254. The listed phone number is (317) 597-2117.

What is Boluwaji Iyiola's specialty?

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

Is Boluwaji Iyiola enrolled in Medicare?

Yes. Boluwaji Iyiola 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 Boluwaji Iyiola's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Boluwaji Iyiola reassigns Medicare benefits to 3 organizations: Mental Health Specialty Group PA (Durham, NC), Grow Healthcare Group PA (Miami, FL) and Cnp Operating Co LLC (IN). 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 Boluwaji Iyiola's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Boluwaji Iyiola accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource and Cigna Healthcare list Boluwaji Iyiola 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 Boluwaji Iyiola was last updated on April 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.