MY PSYCH PROVIDER LLC
NPI 1730954595
Nurse Practitioner - Psychiatric/Mental Health in Rockaway, NJ
About My Psych Provider Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MY PSYCH PROVIDER LLC (NPI 1730954595) is a healthcare organization registered as a psychiatric/mental health in Rockaway, New Jersey and active in the NPI registry since November 2023. The organization lists Samuel Okechukwu, Psychiatric Nurse Practitioner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
My Psych Provider Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to My Psych Provider LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 My Psych Provider LLC's NPI number?
The NPI number for My Psych Provider LLC is 1730954595. It was assigned to this organization in the NPPES registry on November 21, 2023.
Where is My Psych Provider LLC located?
My Psych Provider LLC is located at 100 Enterprise Dr Ste 301, Rockaway, NJ 07866. The listed phone number is (973) 791-9365.
What is My Psych Provider LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is My Psych Provider LLC enrolled in Medicare?
Yes. My Psych Provider LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through My Psych Provider LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to My Psych Provider LLC. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for My Psych Provider LLC was last updated on November 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# My Psych Provider Llc · NPI 1730954595
Psychiatric/Mental Health organization in Rockaway, New Jersey. Organization record, active in the CMS NPPES registry since November 21, 2023.
## Identity
- **NPI:** 1730954595 (Entity type: Organization)
- **Enumerated:** November 21, 2023
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** No
- **Authorized official:** Samuel Okechukwu, PSYCHIATRIC NURSE PRACTITIONER
## Practice location
- **Address:** 100 ENTERPRISE DR STE 301, Rockaway, NJ 07866-2129
- **Phone:** (973) 791-9365 · **Fax:** (973) 869-2449
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 29, 2023
---
Source: [NPI Profile](https://npiprofile.com/npi/1730954595) · Data from the CMS NPPES public registry.