ICONICHEALTH LLC
NPI 1972106292
Nurse Practitioner - Psychiatric/Mental Health in Ewing, NJ
About Iconichealth Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ICONICHEALTH LLC (NPI 1972106292) is a healthcare organization registered as a psychiatric/mental health in Ewing, New Jersey and active in the NPI registry since November 2020. The organization lists Olasumbo Joseph Oladeru, Chief Operating Officer, 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)
Iconichealth 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 Iconichealth 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 Iconichealth LLC's NPI number?
The NPI number for Iconichealth LLC is 1972106292. It was assigned to this organization in the NPPES registry on November 19, 2020.
Where is Iconichealth LLC located?
Iconichealth LLC is located at 1901 N Olden Avenue Ext Ste 11A, Ewing, NJ 08618. The listed phone number is (609) 583-4970.
What is Iconichealth LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Iconichealth LLC enrolled in Medicare?
Yes. Iconichealth LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Iconichealth LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Iconichealth 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 Iconichealth LLC was last updated on January 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.
# Iconichealth Llc · NPI 1972106292
Psychiatric/Mental Health organization in Ewing, New Jersey. Organization record, active in the CMS NPPES registry since November 19, 2020.
## Identity
- **NPI:** 1972106292 (Entity type: Organization)
- **Enumerated:** November 19, 2020
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** No
- **Authorized official:** Olasumbo Oladeru, CHIEF OPERATING OFFICER
## Practice location
- **Address:** 1901 N OLDEN AVENUE EXT STE 11A, Ewing, NJ 08618-2100
- **Phone:** (609) 583-4970 · **Fax:** (609) 323-7385
## 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:** January 28, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1972106292) · Data from the CMS NPPES public registry.