MR. OGHENERO LUCKY OLOMUKORO (PMHNP-BC) – Psychiatric/Mental Health Nurse Practitioner, NPI 1437899689
Psychiatric/Mental Health Nurse Practitioner
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Profile Insights
NPPES metrics only — not quality of care.
7,017 NURSE PRACTITIONER in MO
Provider Addresses for MR. OGHENERO LUCKY OLOMUKORO (PMHNP-BC)
13675 Evergreen Glen Dr
Saint Louis, MO 631284273
Phone: (410) 574-4955
Type: Location
4 MEMORIAL DR STE 210
ALTON, IL 620026704
Phone: (618) 465-8829
Fax: (618) 465-5499
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $153.
Total Amount is formed as General ($153) + Research ($0) + Ownership ($0) = $153.
Last reported payment date: 2024-05-01 • Largest payer in this snapshot: ABBVIE INC. ($131).
Total Amount
$153
General + Research + Ownership
Payments
3
Total payment records
General Amount
$153
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-01
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $131 |
| Hologic Sales and Service, LLC | $22 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-11-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20221111002084 | I | Nurse Practitioner | IL | TBD |
| I20251120000493 | I | Nurse Practitioner | MO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 63128)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IL |
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